Provider Demographics
NPI:1427404938
Name:RARDIN, GENA MARIA
Entity Type:Individual
Prefix:
First Name:GENA
Middle Name:MARIA
Last Name:RARDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1286 SUNBURST WAY SE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-3425
Mailing Address - Country:US
Mailing Address - Phone:320-405-7600
Mailing Address - Fax:
Practice Address - Street 1:1286 SUNBURST WAY SE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-3425
Practice Address - Country:US
Practice Address - Phone:320-405-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304146101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)