MEDICARE: EVE MARIE KALDAHL LPC

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	101YP2500X	Professional Counselor	01080	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01080	OTHER	MN	LICENSE

General Provider Information

NPI Number	:	1548548274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVE MARIE KALDAHL LPC

Provider Business Mailing Address
First Line	:	5833 PECAN ST
Second Line	:	P.O. BOX 723
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-6689
Country	:	US
Telephone Number	:	651-277-4283
Fax Number	:	651-277-4284

Provider Business Practice Location Address
First Line	:	5833 PECAN ST
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-6689
Country	:	US
Telephone Number	:	651-277-4283
Fax Number	:	651-277-4284

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

Provider Enumeration Date	:	07/29/2011
Last Update Date	:	07/29/2011

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