Provider Demographics
NPI:1891046819
Name:RORVIG, SHERYL RUTH (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SHERYL
Middle Name:RUTH
Last Name:RORVIG
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 CENTRE POINTE CURV
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1280
Mailing Address - Country:US
Mailing Address - Phone:651-395-5102
Mailing Address - Fax:651-917-1018
Practice Address - Street 1:1150 CENTRE POINTE CURV
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120-1280
Practice Address - Country:US
Practice Address - Phone:651-395-5102
Practice Address - Fax:651-917-1018
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10162101YM0800X, 103K00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA097725000Medicaid