| Birchwood Therapeutic Services | |
|
115 5th St N Breckenridge MN 56520-1434 | |
| (218) 643-9330 | |
| (218) 641-1001 |
| Full Name | Birchwood Therapeutic Services |
|---|---|
| Speciality | Counselor |
| Location | 115 5th St N, Breckenridge, Minnesota |
| Authorized Official Name and Position | Peg Viele (BILLING MANAGER) |
| Authorized Official Contact | 2186439330 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Birchwood Therapeutic Services 115 5th St N Breckenridge MN 56520-1434 Ph: (218) 643-9330 | Birchwood Therapeutic Services 115 5th St N Breckenridge MN 56520-1434 Ph: (218) 643-9330 |
| NPI Number | 1578614038 |
|---|---|
| Provider Enumeration Date | 01/12/2007 |
| Last Update Date | 01/27/2022 |
| Certification Date | 01/27/2022 |
| Medicare PECOS PAC ID | 7416289277 |
|---|---|
| Medicare Enrollment ID | O20191028001574 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578614038 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 00206 (Minnesota) | Primary |
| 1041C0700X | Social Worker - Clinical | 6408 (Minnesota) | Secondary |
| Provider Name | Donya B Blair Tischer |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1699174326 PECOS PAC ID: 1951682384 Enrollment ID: I20161227000300 |
| Provider Name | Melissa D Gedrose |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366989865 PECOS PAC ID: 8921360967 Enrollment ID: I20180403000007 |
| Provider Name | Allie Catherine Skjonsberg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932697786 PECOS PAC ID: 3476899345 Enrollment ID: I20190628001769 |
| Provider Name | Lori Cline |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306360649 PECOS PAC ID: 2961883194 Enrollment ID: I20240125004376 |
| Provider Name | Denae Haagenson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1063948263 PECOS PAC ID: 3072951797 Enrollment ID: I20240401001625 |
| Provider Name | Ashley E. Thompson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1285009159 PECOS PAC ID: 8325370182 Enrollment ID: I20240508002279 |
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