Healthcare Provider Details

I. General information

NPI: 1407127517
Provider Name (Legal Business Name): JOYCE POPP L.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2012
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 WILLSON RD # 450
EDINA MN
55424-1332
US

IV. Provider business mailing address

1901 EMERSON AVE S APT 403
MINNEAPOLIS MN
55403-2968
US

V. Phone/Fax

Practice location:
  • Phone: 952-929-3103
  • Fax: 952-929-8038
Mailing address:
  • Phone: 612-377-5724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2081
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: