| Parkdale Therapy Group, Llc | |
|
1000 Shelard Pkwy Ste 520 St Louis Park MN 55426-1053 | |
| (952) 224-0399 | |
| (952) 224-0396 |
| Full Name | Parkdale Therapy Group, Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 1000 Shelard Pkwy Ste 520, St Louis Park, Minnesota |
| Authorized Official Name and Position | John Lamont Jankord (CEO) |
| Authorized Official Contact | 9522240399 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Parkdale Therapy Group, Llc 1000 Shelard Pkwy Ste 520 St Louis Park MN 55426-1053 Ph: (952) 224-0399 | Parkdale Therapy Group, Llc 1000 Shelard Pkwy Ste 520 St Louis Park MN 55426-1053 Ph: (952) 224-0399 |
| NPI Number | 1275723777 |
|---|---|
| Provider Enumeration Date | 07/31/2007 |
| Last Update Date | 08/03/2020 |
| Certification Date | 08/03/2020 |
| Medicare PECOS PAC ID | 8921355496 |
|---|---|
| Medicare Enrollment ID | O20180716002760 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275723777 | NPI | - | NPPES |
| Provider Name | Kate Schmidt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093266074 PECOS PAC ID: 3971916941 Enrollment ID: I20210112001632 |
| Provider Name | Megan Rowe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275034605 PECOS PAC ID: 4385906585 Enrollment ID: I20231018003254 |
| Provider Name | John Lamont Jankord |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1215938410 PECOS PAC ID: 2567719032 Enrollment ID: I20240111004648 |
| Provider Name | Michelle Ann Craveiro |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1497755409 PECOS PAC ID: 5193160117 Enrollment ID: I20240229003150 |
| Provider Name | Megan Ann Jankord |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1447947817 PECOS PAC ID: 7911349840 Enrollment ID: I20240523002727 |
| Provider Name | Tyra Hughes |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1316334535 PECOS PAC ID: 2163864968 Enrollment ID: I20240524001457 |
| Provider Name | Maureen Trefethren |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1932643707 PECOS PAC ID: 0143662650 Enrollment ID: I20240530000140 |
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