Provider Demographics
NPI:1821277328
Name:RORVIG, LISA K (MSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:RORVIG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:K
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1128 WESTRAC DR S STE A
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-8729
Mailing Address - Country:US
Mailing Address - Phone:218-329-9502
Mailing Address - Fax:
Practice Address - Street 1:1128 WESTRAC DR S STE A
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-8729
Practice Address - Country:US
Practice Address - Phone:218-329-9502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
ND41941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical