| Autism Society Of Minnesota | |
|
2380 Wycliff St Suite 102 Saint Paul MN 55114-1279 | |
| (651) 647-1083 | |
| Not Available |
| Full Name | Autism Society Of Minnesota |
|---|---|
| Speciality | Psychologist |
| Location | 2380 Wycliff St, Saint Paul, Minnesota |
| Authorized Official Name and Position | Dawn Brasch (DIRECTOR) |
| Authorized Official Contact | 6516471083 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Autism Society Of Minnesota 2380 Wycliff St Suite 102 Saint Paul MN 55114-1279 Ph: (651) 647-1083 | Autism Society Of Minnesota 2380 Wycliff St Suite 102 Saint Paul MN 55114-1279 Ph: (651) 647-1083 |
| NPI Number | 1447236609 |
|---|---|
| Provider Enumeration Date | 12/20/2005 |
| Last Update Date | 07/21/2022 |
| Certification Date | 02/20/2020 |
| Medicare PECOS PAC ID | 8224921242 |
|---|---|
| Medicare Enrollment ID | O20040204000474 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447236609 | NPI | - | NPPES |
| 323J8AU | Other | MN | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Barbara R Luskin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1568448728 PECOS PAC ID: 0345133385 Enrollment ID: I20040204000631 |
| Provider Name | James P Rechs |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437271186 PECOS PAC ID: 7416005806 Enrollment ID: I20090422000624 |
| Provider Name | Maura Mcdonald |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1114432945 PECOS PAC ID: 7214372564 Enrollment ID: I20240227002001 |
| Provider Name | Sara Lahti |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669950606 PECOS PAC ID: 3779928973 Enrollment ID: I20240227004440 |
| Provider Name | Elizabeth Pitchford |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1285047704 PECOS PAC ID: 9032555032 Enrollment ID: I20240313001104 |
| Provider Name | Bjorn Viking Walter |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1609362151 PECOS PAC ID: 8527405547 Enrollment ID: I20240326000764 |
| Provider Name | Sara Joanne Pahl |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1194085746 PECOS PAC ID: 4486091311 Enrollment ID: I20240327000920 |
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