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General NPI Number Information
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NPI Number | 1447324512
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Entity Type | Individual
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Provider Name | ARDITH ANN MESSICCI MA LP
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Gender | Female
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 13700 83RD WAY SUITE 205
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City | MAPLE GROVE
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State | MN
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Zip | 55369-7015
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Country | US
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Telephone | 763-494-8699
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Fax | 763-494-8797
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Provider Business Mailing Address
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Address Line | 3724 AUGER AVE
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-4617
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Country | US
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Telephone | 541-429-1326
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Fax | 763-494-8797
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP0951
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License Number State | MN
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