Most Relevant Information
Provider Data
| NPI Number: | 1003658527 |
| Provider Name: | AUTUMN VASICHEK |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/07/2024 |
| Last Updated: | 06/07/2024 |
Provider Practice Location
151 S 4TH ST STE 201
GRAND FORKS
ND
582014715
Practice Location Phone/Fax
| Phone: | 7017878522 |
| Fax: |
Provider Mailing Location
151 S 4TH ST STE 201
GRAND FORKS
ND
582014715
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |