Provider Demographics
NPI:1528120052
Name:HUSTED, JOHN RICE (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RICE
Last Name:HUSTED
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 WILLIMANTIC DR NW
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-4790
Mailing Address - Country:US
Mailing Address - Phone:320-763-9984
Mailing Address - Fax:
Practice Address - Street 1:85 WILLIMANTIC DR NW
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-4790
Practice Address - Country:US
Practice Address - Phone:320-763-9984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1792103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist