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NPI Code Detail

MEDICARE: JOHN P RISLOVE LICSW

MEDICARE: JOHN P RISLOVE LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist7561MN
2103TC0700XClinical Psychologist3840123WI
31041C0700XClinical Social Worker3840WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1118042OTHERMNU CARE
25H180RIOTHERMNBCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396727376
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN P RISLOVE LICSW
Provider Business Mailing Address
First Line : 1836 SOUTH AVE
Second Line :
City : LA CROSSE
State : WI
Zip : 54601-5429
Country : US
Telephone Number : 608-782-7300
Fax Number :
Provider Business Practice Location Address
First Line : 123 16TH AVE S
Second Line :
City : ONALASKA
State : WI
Zip : 54650-3109
Country : US
Telephone Number : 608-796-8646
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2005
Last Update Date : 09/11/2025

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