Provider Demographics
NPI:1851664494
Name:CARUSO, RICHARD FJ (BC-HIS, HID)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:FJ
Last Name:CARUSO
Suffix:
Gender:M
Credentials:BC-HIS, HID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16701 94TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-5448
Mailing Address - Country:US
Mailing Address - Phone:763-273-9031
Mailing Address - Fax:
Practice Address - Street 1:16701 94TH AVE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-5448
Practice Address - Country:US
Practice Address - Phone:763-273-9031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2601237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist