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General NPI Number Information
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NPI Number | 1902926124
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Entity Type | Individual
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Provider Name | RICHARD AYLWARD
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Gender | Male
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1025 DODD RD
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City | SAINT PAUL
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State | MN
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Zip | 55118-1113
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Country | US
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Telephone | 651-450-2220
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Fax |
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Provider Business Mailing Address
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Address Line | 17201 RABBIT ST NW
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City | RAMSEY
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State | MN
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Zip | 55303-5579
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Country | US
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Telephone | 763-441-7116
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 169692
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License Number State | MN
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