Provider Demographics
NPI:1003466848
Name:DAUER, RICHARD (LADC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:DAUER
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 LEXINGTON PKWY S APT 403
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1748
Mailing Address - Country:US
Mailing Address - Phone:651-425-1708
Mailing Address - Fax:
Practice Address - Street 1:6470 129TH ST W
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-5300
Practice Address - Country:US
Practice Address - Phone:651-402-9564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301150101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)