Provider Demographics
NPI:1831826593
Name:PROSPER, GEORGES W
Entity type:Individual
Prefix:
First Name:GEORGES
Middle Name:W
Last Name:PROSPER
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 1:700 RAVOUX RD
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1328
Mailing Address - Country:US
Mailing Address - Phone:256-755-1582
Mailing Address - Fax:
Practice Address - Street 1:700 RAVOUX RD
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1328
Practice Address - Country:US
Practice Address - Phone:256-755-1582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker