Healthcare Provider Details

I. General information

NPI: 1306067848
Provider Name (Legal Business Name): MELISSA JANE WENSZELL SAMBORKSI MT-BC, NMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S 2ND ST
MINNEAPOLIS MN
55401-2383
US

IV. Provider business mailing address

6428 WENTWORTH AVE
RICHFIELD MN
55423-1515
US

V. Phone/Fax

Practice location:
  • Phone: 612-321-0100
  • Fax: 612-767-5556
Mailing address:
  • Phone: 612-281-0307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number225A00000X
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: