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5200 Willson Rd Ste 150 Edina MN 55424-1300 | |
| (612) 416-3311 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 5200 Willson Rd Ste 150, Edina, Minnesota |
| Authorized Official Name and Position | Katherine Fabrizio (OWNER) |
| Authorized Official Contact | 6124163311 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5200 Willson Rd Ste 150 Edina MN 55424-1300 Ph: (612) 416-3311 | 5200 Willson Rd Ste 150 Edina MN 55424-1300 Ph: (612) 416-3311 |
| NPI Number | 1700631686 |
|---|---|
| Provider Enumeration Date | 04/23/2024 |
| Last Update Date | 04/28/2024 |
| Certification Date | 04/23/2024 |
| Medicare PECOS PAC ID | 4082154869 |
|---|---|
| Medicare Enrollment ID | O20240906003360 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700631686 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Katherine S Fabrizio |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1609895531 PECOS PAC ID: 6406009588 Enrollment ID: I20130124000147 |
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