Provider Demographics
NPI:1003468547
Name:RECTOR, NOAH (LICSW, LADC, MED)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:RECTOR
Suffix:
Gender:M
Credentials:LICSW, LADC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2353 RICE ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55113-3721
Mailing Address - Country:US
Mailing Address - Phone:612-979-2683
Mailing Address - Fax:
Practice Address - Street 1:2353 RICE ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55113-3739
Practice Address - Country:US
Practice Address - Phone:612-979-2683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303990101YA0400X
MN237921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)