Healthcare Provider Details

I. General information

NPI: 1366367187
Provider Name (Legal Business Name): MARTHA MCDERMOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 YORK AVE S STE 350
EDINA MN
55435-5832
US

IV. Provider business mailing address

7701 YORK AVE S STE 350
EDINA MN
55435-5832
US

V. Phone/Fax

Practice location:
  • Phone: 952-926-2526
  • Fax: 952-926-6791
Mailing address:
  • Phone: 952-926-2526
  • Fax: 952-926-6791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: