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NPI Code Detail

MEDICARE: JACLYN RACHELLE RICE

MEDICARE: JACLYN RACHELLE RICE
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1457833204
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACLYN RACHELLE RICE
Provider Business Mailing Address
First Line : 1900 SILVER LAKE RD NW
Second Line :
City : NEW BRIGHTON
State : MN
Zip : 55112-1786
Country : US
Telephone Number : 651-628-9566
Fax Number :
Provider Business Practice Location Address
First Line : 11660 ROUND LAKE BLVD NW
Second Line :
City : COON RAPIDS
State : MN
Zip : 55433-2638
Country : US
Telephone Number : 763-767-3350
Fax Number : 763-767-0912
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2018
Last Update Date : 07/22/2019

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Directions to “ JACLYN RACHELLE RICE ” Practice Location

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