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General NPI Number Information
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NPI Number | 1053536854
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Entity Type | Organization
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Legal Business Name | SONLIGHT THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 505 S 12TH AVE
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City | VIRGINIA
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State | MN
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Zip | 55792-3099
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Country | US
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Telephone | 218-741-5110
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Fax | 218-741-5110
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Provider Business Mailing Address
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Address Line | 505 S 12TH AVE
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City | VIRGINIA
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State | MN
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Zip | 55792-3099
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Country | US
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Telephone | 218-741-5110
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Fax | 218-741-5110
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Authorized Official
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Title or Position | LICENSED THERAPIST
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Name | MR. ROGER PAUL LINDEN
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Credential | L.I.C.S.W
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Telephone | 218-741-5110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 145
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License Number State | MN
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