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3505 8th St S Ste 3 Moorhead MN 56560-5108 | |
| (701) 532-0991 | |
| (701) 532-0428 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 3505 8th St S Ste 3, Moorhead, Minnesota |
| Authorized Official Name and Position | Lisa Joyce Keller Salvaggio (OWNER) |
| Authorized Official Contact | 7017207222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3615 17th St S Moorhead MN 56560-7050 Ph: (701) 720-7222 | 3505 8th St S Ste 3 Moorhead MN 56560-5108 Ph: (701) 532-0991 |
| NPI Number | 1124725361 |
|---|---|
| Provider Enumeration Date | 02/08/2023 |
| Last Update Date | 10/21/2024 |
| Certification Date | 10/21/2024 |
| Medicare PECOS PAC ID | 5496120453 |
|---|---|
| Medicare Enrollment ID | O20230405002602 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124725361 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Lisa Joyce Keller Salvaggio |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1346676897 PECOS PAC ID: 9638497647 Enrollment ID: I20190411000051 |
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