| Melissa Anderson Psychological Services, Pllc | |
|
316 Elm Ave Moose Lake MN 55767-7706 | |
| (218) 485-4445 | |
| (218) 485-0477 |
| Full Name | Melissa Anderson Psychological Services, Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 316 Elm Ave, Moose Lake, Minnesota |
| Authorized Official Name and Position | Melissa Jean Anderson (PSYCHOLOGIST/OWNER) |
| Authorized Official Contact | 2184854445 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Melissa Anderson Psychological Services, Pllc 316 Elm Ave Po Box 243 Moose Lake MN 55767-7706 Ph: (218) 485-4445 | Melissa Anderson Psychological Services, Pllc 316 Elm Ave Moose Lake MN 55767-7706 Ph: (218) 485-4445 |
| NPI Number | 1306224365 |
|---|---|
| Provider Enumeration Date | 05/11/2015 |
| Last Update Date | 05/11/2015 |
| Medicare PECOS PAC ID | 0547589723 |
|---|---|
| Medicare Enrollment ID | O20150611002223 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306224365 | NPI | - | NPPES |
| 094906000 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 5864 (Minnesota) | Primary |
| 106H00000X | Marriage & Family Therapist | 1494 (Minnesota) | Secondary |
| Provider Name | Melissa Jean Anderson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548226251 PECOS PAC ID: 6204157563 Enrollment ID: I20150611002425 |
| Provider Name | Dana M Osborne |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033395751 PECOS PAC ID: 6406123892 Enrollment ID: I20170607000623 |
| Provider Name | Jaime L Wuori |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720581663 PECOS PAC ID: 0345595716 Enrollment ID: I20180626003183 |
Shaffer Professional Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 501 Arrowhead Ln, Moose Lake, MN 55767 Phone: 218-380-0175 Fax: 218-485-9105 |