Healthcare Provider Details

I. General information

NPI: 1972057644
Provider Name (Legal Business Name): ACCESS HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5861 CEDAR LAKE RD S
MINNEAPOLIS MN
55416-1653
US

IV. Provider business mailing address

7060 IMHOFF AVE NW
MAPLE LAKE MN
55358-2431
US

V. Phone/Fax

Practice location:
  • Phone: 763-541-1393
  • Fax:
Mailing address:
  • Phone: 763-541-1393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JUDY GOLDETSKY
Title or Position: CEO
Credential:
Phone: 763-545-6017