Healthcare Provider Details

I. General information

NPI: 1578661534
Provider Name (Legal Business Name): MARILYN ANNE GANJE-FLING M.A.,L.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 PARK GLEN RD SUITE 350
MINNEAPOLIS MN
55416-4871
US

IV. Provider business mailing address

4839 COLFAX AVE S
MINNEAPOLIS MN
55419-5319
US

V. Phone/Fax

Practice location:
  • Phone: 952-929-1905
  • Fax: 952-929-1771
Mailing address:
  • Phone: 952-929-1905
  • Fax: 952-929-1771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1330
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: