Provider Demographics
NPI:1033290267
Name:RUPP, DAVID R (MA, LADC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:R
Last Name:RUPP
Suffix:
Gender:M
Credentials:MA, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 9TH ST
Mailing Address - Street 2:P O BOX 443
Mailing Address - City:WINDOM
Mailing Address - State:MN
Mailing Address - Zip Code:56101-0443
Mailing Address - Country:US
Mailing Address - Phone:507-831-4699
Mailing Address - Fax:507-831-4755
Practice Address - Street 1:305 9TH ST
Practice Address - Street 2:
Practice Address - City:WINDOM
Practice Address - State:MN
Practice Address - Zip Code:56101-0443
Practice Address - Country:US
Practice Address - Phone:507-831-4699
Practice Address - Fax:507-831-4755
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301173101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)