Healthcare Provider Details

I. General information

NPI: 1083220602
Provider Name (Legal Business Name): GOLDFINCH NEUROBEHAVIORAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6640 SHADY OAK RD STE 375
EDEN PRAIRIE MN
55344-7834
US

IV. Provider business mailing address

6640 SHADY OAK RD STE 375
EDEN PRAIRIE MN
55344-7834
US

V. Phone/Fax

Practice location:
  • Phone: 952-236-1267
  • Fax:
Mailing address:
  • Phone: 952-236-1267
  • Fax: 952-236-4799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: SHERYL PLEISS
Title or Position: OWNER
Credential: PHD, LP
Phone: 952-236-1267