Individual
JACK RIVALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
287 6TH ST E STE 300, SAINT PAUL, MN 55101-1690
(651) 221-0334
Mailing address
287 6TH ST E STE 300, SAINT PAUL, MN 55101-1690
(651) 221-0334
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
304229
MN
Other
Enumeration date
01/08/2020
Last updated
01/08/2020
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