Individual
MR. DAVIS RICHARD DODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S.
Contact information
Practice address
7601 WAYZATA BLVD, ST LOUIS PARK, MN 55426-1623
(603) 391-2136
Mailing address
1760 COLETTE DR APT 4, NORTH MANKATO, MN 56003-1905
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
06/08/2023
Last updated
06/08/2023
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