| Practice Place, Pllc | |
|
2534 17th Ave S Ste E Grand Forks ND 58201-5215 | |
| (208) 406-9794 | |
| Not Available |
| Full Name | Practice Place, Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 2534 17th Ave S Ste E, Grand Forks, North Dakota |
| Authorized Official Name and Position | Sherman Maurice Normandin (PSYCHOLOGIST) |
| Authorized Official Contact | 7018854551 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Practice Place, Pllc 2534 17th Ave S Ste E Grand Forks ND 58201-5215 Ph: (701) 885-4551 | Practice Place, Pllc 2534 17th Ave S Ste E Grand Forks ND 58201-5215 Ph: (208) 406-9794 |
| NPI Number | 1184283541 |
|---|---|
| Provider Enumeration Date | 06/10/2019 |
| Last Update Date | 07/22/2024 |
| Certification Date | 07/22/2024 |
| Medicare PECOS PAC ID | 2860721164 |
|---|---|
| Medicare Enrollment ID | O20190911003931 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184283541 | NPI | - | NPPES |
| 1083630974 | Medicaid | ND | |
| 1033210570 | Medicaid | ND | |
| 1124128756 | Medicaid | ND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jeanine E Kotschwar |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1083630974 PECOS PAC ID: 0143488064 Enrollment ID: I20120223000673 |
| Provider Name | Kelsey Vivatson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043945397 PECOS PAC ID: 3072989714 Enrollment ID: I20221020000621 |
| Provider Name | Leslie Rowan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1033210570 PECOS PAC ID: 4688906506 Enrollment ID: I20230801001509 |
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