MEDICARE: DYNAMIC PATH PSYCHOLOGICAL SERVICES, LLC

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	5411	MN

General Provider Information

NPI Number	:	1275819914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC PATH PSYCHOLOGICAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	5874 BLACKSHIRE PATH
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-1621
Country	:	US
Telephone Number	:	651-317-3656
Fax Number	:	888-965-5676

Provider Business Practice Location Address
First Line	:	5874 BLACKSHIRE PATH
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-1621
Country	:	US
Telephone Number	:	651-317-3656
Fax Number	:	888-965-5676

Authorized Official
Title or Position	:	OWNER, SOLE OPERATOR
Name	:	DR. KATRINA SAMLASKA
Credential	:
Telephone Number	:	651-317-3656

Provider Enumeration Date	:	10/26/2011
Last Update Date	:	11/02/2025

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