Individual
MR. RUSSELL R FAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
1679 6TH AVE W, DICKINSON, ND 58601-2904
(701) 483-1000
(701) 483-1001
Mailing address
1679 6TH AVE W, DICKINSON, ND 58601-2904
(701) 483-1000
(701) 483-1001
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2212
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12990
BC/BS PIN
ND
05
—
1455118
—
ND
Enumeration date
07/03/2006
Last updated
02/13/2020
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