| Mankato Mental Health Associates, Pa | |
|
209 S Broad St Suite C Mankato MN 56001-3681 | |
| (507) 345-4448 | |
| (507) 625-1000 |
| Full Name | Mankato Mental Health Associates, Pa |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 209 S Broad St, Mankato, Minnesota |
| Authorized Official Name and Position | Dawn Marie Ulrich (DIRECTOR/PRESIDENT/CEO) |
| Authorized Official Contact | 5073454448 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mankato Mental Health Associates, Pa 209 S Broad St Suite C Mankato MN 56001-3681 Ph: (507) 345-4448 | Mankato Mental Health Associates, Pa 209 S Broad St Suite C Mankato MN 56001-3681 Ph: (507) 345-4448 |
| NPI Number | 1083863245 |
|---|---|
| Provider Enumeration Date | 09/11/2008 |
| Last Update Date | 09/11/2008 |
| Medicare PECOS PAC ID | 1153647508 |
|---|---|
| Medicare Enrollment ID | O20150303001177 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083863245 | NPI | - | NPPES |
| 602022400 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LP3697 (Minnesota) | Primary |
| Provider Name | George W Clements |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194870881 PECOS PAC ID: 3577578970 Enrollment ID: I20060207000104 |
| Provider Name | Rebecca Ah Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366706376 PECOS PAC ID: 0749436533 Enrollment ID: I20120809000942 |
| Provider Name | Katie Marie Stadheim |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376936047 PECOS PAC ID: 1759608748 Enrollment ID: I20150401001281 |
| Provider Name | Paul Lawrence Matson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235678954 PECOS PAC ID: 8729330337 Enrollment ID: I20181010000331 |
| Provider Name | Jacqueline A Tohal |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659837847 PECOS PAC ID: 7113352022 Enrollment ID: I20200123001724 |
| Provider Name | Katarina L Barrett Krzmarzick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275173445 PECOS PAC ID: 3577993146 Enrollment ID: I20200422001670 |
| Provider Name | Laura C Schultz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699453084 PECOS PAC ID: 8123479029 Enrollment ID: I20240104002787 |
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