Provider Demographics
NPI:1548800238
Name:SANDVIG, RILEY JAMES
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:JAMES
Last Name:SANDVIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BRIARGATE RD APT E3
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5031
Mailing Address - Country:US
Mailing Address - Phone:605-838-6068
Mailing Address - Fax:
Practice Address - Street 1:150 BRIARGATE RD APT E3
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5031
Practice Address - Country:US
Practice Address - Phone:605-838-6068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician