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4208 Park Glen Rd Minneapolis MN 55416-4758 | |
| (630) 677-5437 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 4208 Park Glen Rd, Minneapolis, Minnesota |
| Authorized Official Name and Position | Elizabeth Vogt (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 6126421754 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4208 Park Glen Rd Minneapolis MN 55416-4758 Ph: (630) 677-5437 | 4208 Park Glen Rd Minneapolis MN 55416-4758 Ph: (630) 677-5437 |
| NPI Number | 1699239566 |
|---|---|
| Provider Enumeration Date | 01/24/2019 |
| Last Update Date | 11/07/2024 |
| Certification Date | 11/07/2024 |
| Medicare PECOS PAC ID | 4284169723 |
|---|---|
| Medicare Enrollment ID | O20241121000828 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699239566 | NPI | - | NPPES |
| 1336374750 | Other | MN | CLINICAL SOCIAL WORKER |
| 1447644224 | Other | MN | SOCIAL WORKER CLINICAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Colette R Molloy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215147491 PECOS PAC ID: 3072813765 Enrollment ID: I20151202001627 |
| Provider Name | Allison N Ward |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770127490 PECOS PAC ID: 9436587649 Enrollment ID: I20200323001866 |
| Provider Name | Jessica Osfar |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1548909039 PECOS PAC ID: 0143754259 Enrollment ID: I20241112003811 |
| Provider Name | Jamie Larson Jones |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1275605388 PECOS PAC ID: 4880129329 Enrollment ID: I20241121001106 |
| Provider Name | Deanna Pelley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912576166 PECOS PAC ID: 2961937388 Enrollment ID: I20241122000067 |
| Provider Name | Rachel Nycklemoe |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922728559 PECOS PAC ID: 8325573751 Enrollment ID: I20241122000090 |
| Provider Name | Camrie Trautman |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1093361115 PECOS PAC ID: 7315472743 Enrollment ID: I20241122000119 |
| Provider Name | Teia Kopari |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902646672 PECOS PAC ID: 6305371733 Enrollment ID: I20241122000209 |
| Provider Name | Sara Ruiz |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1932744067 PECOS PAC ID: 3476088808 Enrollment ID: I20241122000278 |
| Provider Name | Hannah Thomas |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1891578332 PECOS PAC ID: 3375078702 Enrollment ID: I20241122000329 |
| Provider Name | Maisa Boyte |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770345076 PECOS PAC ID: 3971038308 Enrollment ID: I20241122000472 |
| Provider Name | Elizabeth Vogt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619161783 PECOS PAC ID: 4880129220 Enrollment ID: I20241122000532 |
| Provider Name | Katharine Simpson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417775289 PECOS PAC ID: 0244765535 Enrollment ID: I20241122003484 |
| Provider Name | Claudia Coleman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023697455 PECOS PAC ID: 0547795429 Enrollment ID: I20241202002228 |
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