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NPI Code Detail

MEDICARE: DR. ELLEN LOWERY PH.D., LP

MEDICARE:  DR. ELLEN  LOWERY  PH.D., 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
1103TC0700XClinical Psychologist00091MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
121266OTHERMNHP
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
361-52204OTHERMNUBH
426D11LOOTHERMNBCBS
51012053OTHERMNP1
6114927OTHERMNUC
7148951OTHERMNCP

General Provider Information

NPI Number : 1730193954
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELLEN LOWERY PH.D., LP
Provider Business Mailing Address
First Line : 7600 BOONE AVE N
Second Line : SUITE 2
City : BROOKLYN PARK
State : MN
Zip : 55428-4563
Country : US
Telephone Number : 763-515-2450
Fax Number :
Provider Business Practice Location Address
First Line : 7600 BOONE AVE N
Second Line : SUITE 2
City : BROOKLYN PARK
State : MN
Zip : 55428-4563
Country : US
Telephone Number : 763-515-2450
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 07/18/2014

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