MEDICARE: THERESE MCCANN FISCHER MA, LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	LP5263	MN

General Provider Information

NPI Number	:	1033430095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESE MCCANN FISCHER MA, LP

Provider Business Mailing Address
First Line	:	4240 PARK GLEN RD
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-5427
Country	:	US
Telephone Number	:	612-925-6033
Fax Number	:	612-925-8496

Provider Business Practice Location Address
First Line	:	450 SYNDICATE ST N STE 385
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-4219
Country	:	US
Telephone Number	:	612-925-6033
Fax Number	:	612-925-8496

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2010
Last Update Date	:	02/22/2022

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