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General NPI Number Information
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NPI Number | 1639615800
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Entity Type | Individual
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Provider Name | JUSTIN MICHAEL MEDNICK
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Gender | Male
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Dates
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Enumeration Date | 01/12/2017
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Last Update Date | 01/12/2017
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Provider Practice Location Address
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Address Line | 101 5TH ST E 208
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City | NORTHFIELD
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State | MN
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Zip | 55057-2067
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Country | US
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Telephone | 507-222-9230
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Fax | 507-786-9877
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Provider Business Mailing Address
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Address Line | 7600 PARKLAWN AVE 380
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City | EDINA
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State | MN
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Zip | 55435-5125
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Country | US
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Telephone | 612-203-2961
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Fax | 952-831-0033
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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