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NPI Code Detail

MEDICARE: MS. JANICE CARLSON JOSHUA PSYD LP

MEDICARE: MS. JANICE CARLSON JOSHUA PSYD 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
1103TC1900XCounseling PsychologistLP1361MN

General Provider Information

NPI Number : 1235276791
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JANICE CARLSON JOSHUA PSYD LP
Provider Business Mailing Address
First Line : 5200 WILLSON RD STE 150
Second Line :
City : EDINA
State : MN
Zip : 55424-1300
Country : US
Telephone Number : 952-926-4554
Fax Number : 952-836-2730
Provider Business Practice Location Address
First Line : 5200 WILLSON RD STE 150
Second Line :
City : EDINA
State : MN
Zip : 55424-1300
Country : US
Telephone Number : 952-926-4554
Fax Number : 952-836-2730
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2007
Last Update Date : 07/08/2007

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