| Lisa S. Squire, Phd, Lp, Pa | |
|
7800 Metro Pkwy Suite 300 Bloomington MN 55425-1514 | |
| (952) 854-2440 | |
| (952) 854-2465 |
| Full Name | Lisa S. Squire, Phd, Lp, Pa |
|---|---|
| Speciality | Psychologist |
| Location | 7800 Metro Pkwy, Bloomington, Minnesota |
| Authorized Official Name and Position | Lisa Sharon Squire (OWNER) |
| Authorized Official Contact | 9528542440 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisa S. Squire, Phd, Lp, Pa 7800 Metro Pkwy Suite 300 Bloomington MN 55425-1514 Ph: (952) 854-2440 | Lisa S. Squire, Phd, Lp, Pa 7800 Metro Pkwy Suite 300 Bloomington MN 55425-1514 Ph: (952) 854-2440 |
| NPI Number | 1841529930 |
|---|---|
| Provider Enumeration Date | 12/18/2009 |
| Last Update Date | 12/18/2009 |
| Medicare PECOS PAC ID | 0345384665 |
|---|---|
| Medicare Enrollment ID | O20100224000239 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841529930 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | MNLP0204 (Minnesota) | Primary |
| Provider Name | Lisa S Squire |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1609872589 PECOS PAC ID: 8729122049 Enrollment ID: I20100224000226 |
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