| --none-- | |
|
601 W Saint Germain St Saint Cloud MN 56301-3665 | |
| (320) 296-2530 | |
| (320) 323-4387 |
| Full Name | --none-- |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 601 W Saint Germain St, Saint Cloud, Minnesota |
| Authorized Official Name and Position | Seal Sophie Dwyer (PRINCIPLE) |
| Authorized Official Contact | 3202962530 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| --none-- 528 7th Ave N Saint Cloud MN 56303-3522 Ph: (320) 296-2530 | --none-- 601 W Saint Germain St Saint Cloud MN 56301-3665 Ph: (320) 296-2530 |
| NPI Number | 1083187579 |
|---|---|
| Provider Enumeration Date | 01/07/2019 |
| Last Update Date | 12/06/2023 |
| Certification Date | 12/06/2023 |
| Medicare PECOS PAC ID | 7315381605 |
|---|---|
| Medicare Enrollment ID | O20240214002537 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083187579 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Seal Sophie Dwyer |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1679059992 PECOS PAC ID: 8224472519 Enrollment ID: I20240214002713 |
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