| Suburban North Psychological Services, P.a. | |
|
1313 5th St Se Mailbox 45, Suite 114 B Minneapolis MN 55414-4504 | |
| (612) 819-7485 | |
| (612) 379-3183 |
| Full Name | Suburban North Psychological Services, P.a. |
|---|---|
| Speciality | Psychologist |
| Location | 1313 5th St Se, Minneapolis, Minnesota |
| Authorized Official Name and Position | Ferde William Fritsche (LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 6516471653 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Suburban North Psychological Services, P.a. 1512 California Ave W Saint Paul MN 55108-2105 Ph: (651) 647-1653 | Suburban North Psychological Services, P.a. 1313 5th St Se Mailbox 45, Suite 114 B Minneapolis MN 55414-4504 Ph: (612) 819-7485 |
| NPI Number | 1972727105 |
|---|---|
| Provider Enumeration Date | 04/12/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 8921267147 |
|---|---|
| Medicare Enrollment ID | O20120307000857 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972727105 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | LP 2514 (Minnesota) | Primary |
| Provider Name | Ferde William Fritsche |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1083838213 PECOS PAC ID: 9739348954 Enrollment ID: I20120307000883 |
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