| Portage Psychology Pa | |
|
10125 Crosstown Cir Ste 110 Eden Prairie MN 55344-3316 | |
| (612) 688-5933 | |
| (612) 500-4607 |
| Full Name | Portage Psychology Pa |
|---|---|
| Speciality | Psychologist |
| Location | 10125 Crosstown Cir Ste 110, Eden Prairie, Minnesota |
| Authorized Official Name and Position | Anna Krull (VICE-PRESIDENT) |
| Authorized Official Contact | 6129863333 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Portage Psychology Pa 10125 Crosstown Cir Ste 110 Eden Prairie MN 55344-3316 Ph: (612) 688-5933 | Portage Psychology Pa 10125 Crosstown Cir Ste 110 Eden Prairie MN 55344-3316 Ph: (612) 688-5933 |
| NPI Number | 1245975010 |
|---|---|
| Provider Enumeration Date | 05/04/2022 |
| Last Update Date | 05/04/2022 |
| Certification Date | 05/04/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245975010 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
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