Bosak Mischke Inc. | |
821 Raymond Ave #300 Saint Paul MN 55114-1525 | |
(651) 647-0659 | |
(651) 646-1424 |
Full Name | Bosak Mischke Inc. |
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Speciality | Psychologist |
Location | 821 Raymond Ave, Saint Paul, Minnesota |
Authorized Official Name and Position | John Mischke (PRESIDENT) |
Authorized Official Contact | 6516470659 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Bosak Mischke Inc. 821 Raymond Ave #300 Saint Paul MN 55114-1525 Ph: (651) 647-0659 | Bosak Mischke Inc. 821 Raymond Ave #300 Saint Paul MN 55114-1525 Ph: (651) 647-0659 |
NPI Number | 1669733762 |
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Provider Enumeration Date | 06/05/2012 |
Last Update Date | 06/05/2012 |
Medicare PECOS PAC ID | 1951710821 |
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Medicare Enrollment ID | O20210505000728 |
Identifier | Type | State | Issuer |
---|---|---|---|
1669733762 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TC1900X | Psychologist - Counseling | LP2396 (Minnesota) | Primary |
1041C0700X | Social Worker - Clinical | 4213 (Minnesota) | Secondary |
Provider Name | Sherie Lou Bosak |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1013158294 PECOS PAC ID: 2860801735 Enrollment ID: I20210505001142 |
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