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General NPI Number Information
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NPI Number | 1467206250
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Entity Type | Organization
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Legal Business Name | RIVERWISE THERAPY PLLC
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Dates
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Enumeration Date | 04/16/2024
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Last Update Date | 04/16/2024
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Provider Practice Location Address
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Address Line | 222 1/2 F ST STE 6
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City | SALIDA
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State | CO
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Zip | 81201-2141
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Country | US
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Telephone | 719-717-9094
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 885
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City | SALIDA
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State | CO
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Zip | 81201-0885
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Country | US
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Telephone | 719-717-9094
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BLAKE BERNLOHR
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Credential |
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Telephone | 719-530-1391
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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 |
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License Number State |
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