Provider Demographics
NPI:1194158899
Name:RESLER, RANDI JO (BA, BCC, LADC)
Entity type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:JO
Last Name:RESLER
Suffix:
Gender:F
Credentials:BA, BCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 E BEECH AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-1623
Mailing Address - Country:US
Mailing Address - Phone:218-282-0638
Mailing Address - Fax:
Practice Address - Street 1:2400 ST. FRANCIS DRIVE
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:MN
Practice Address - Zip Code:56520
Practice Address - Country:US
Practice Address - Phone:218-643-0499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303661101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN410695598OtherST FRANCIS HEALTHCARE CAMPUS