Healthcare Provider Details

I. General information

NPI: 1609697036
Provider Name (Legal Business Name): MICHELE BRATT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2388 UNIVERSITY AVE W STE 202
SAINT PAUL MN
55114-1769
US

IV. Provider business mailing address

201 CECIL ST SE
MINNEAPOLIS MN
55414-3612
US

V. Phone/Fax

Practice location:
  • Phone: 800-945-2401
  • Fax: 651-300-2702
Mailing address:
  • Phone: 612-799-7103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: