| Michelle A Kosmak Licsw Llc | |
|
8085 Wayzata Blvd Ste 101b Golden Valley MN 55426-1468 | |
| (612) 825-1559 | |
| (612) 545-0100 |
| Full Name | Michelle A Kosmak Licsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 8085 Wayzata Blvd Ste 101b, Golden Valley, Minnesota |
| Authorized Official Name and Position | Michelle Kosmak (OWNER/CLINICIAN) |
| Authorized Official Contact | 6128251559 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michelle A Kosmak Licsw Llc 8085 Wayzata Blvd Ste 101b Golden Valley MN 55426-1468 Ph: (612) 825-1559 | Michelle A Kosmak Licsw Llc 8085 Wayzata Blvd Ste 101b Golden Valley MN 55426-1468 Ph: (612) 825-1559 |
| NPI Number | 1487283644 |
|---|---|
| Provider Enumeration Date | 04/08/2020 |
| Last Update Date | 04/08/2020 |
| Certification Date | 04/08/2020 |
| Medicare PECOS PAC ID | 7719317726 |
|---|---|
| Medicare Enrollment ID | O20200415000506 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487283644 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Michelle A Kosmak |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578655759 PECOS PAC ID: 8628408630 Enrollment ID: I20200415000615 |
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