Individual
RUSSELL ROWENHORST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
1103 AVENUE B, CLOQUET, MN 55720-1638
(218) 878-2574
Mailing address
431 18TH ST, CLOQUET, MN 55720-2205
(218) 428-9829
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6241
MN
Other
Enumeration date
09/18/2018
Last updated
09/18/2018
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