Provider Demographics
NPI:1851538235
Name:DWORSKY, RICHARD JOEL (SLP CCC MA MM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOEL
Last Name:DWORSKY
Suffix:
Gender:M
Credentials:SLP CCC MA MM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10535 170TH ST W
Mailing Address - Street 2:
Mailing Address - City:KILKENNY
Mailing Address - State:MN
Mailing Address - Zip Code:56052-9642
Mailing Address - Country:US
Mailing Address - Phone:507-210-1862
Mailing Address - Fax:507-331-3102
Practice Address - Street 1:303 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5268
Practice Address - Country:US
Practice Address - Phone:507-331-3010
Practice Address - Fax:507-331-3102
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5368235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist