| Spaulding Professional Corporation | |
|
1409 Willow Street Suite 300 Minneapolis MN 55403-2293 | |
| (612) 870-1242 | |
| (612) 870-8077 |
| Full Name | Spaulding Professional Corporation |
|---|---|
| Speciality | Psychologist |
| Location | 1409 Willow Street, Minneapolis, Minnesota |
| Authorized Official Name and Position | Patricia Spaulding (OWNER) |
| Authorized Official Contact | 6128701242 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Spaulding Professional Corporation 1409 Willow Street Suite 300 Minneapolis MN 55403-2293 Ph: (612) 870-1242 | Spaulding Professional Corporation 1409 Willow Street Suite 300 Minneapolis MN 55403-2293 Ph: (612) 870-1242 |
| NPI Number | 1467492702 |
|---|---|
| Provider Enumeration Date | 06/07/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 6406935667 |
|---|---|
| Medicare Enrollment ID | O20080430000135 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467492702 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | LP2564 (Minnesota) | Primary |
| Provider Name | Patricia P Spaulding |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1881863975 PECOS PAC ID: 6507945763 Enrollment ID: I20080430000130 |
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