Provider Demographics
NPI:1538410246
Name:NEUHARDT, RILEY BRUCE (MS LP)
Entity type:Individual
Prefix:MR
First Name:RILEY
Middle Name:BRUCE
Last Name:NEUHARDT
Suffix:
Gender:M
Credentials:MS LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 W ALCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2661
Mailing Address - Country:US
Mailing Address - Phone:651-231-3907
Mailing Address - Fax:218-739-1329
Practice Address - Street 1:1801 W ALCOTT AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2661
Practice Address - Country:US
Practice Address - Phone:651-231-3907
Practice Address - Fax:218-739-1329
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 1275103TC0700X, 283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No283Q00000XHospitalsPsychiatric Hospital