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General NPI Number Information
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NPI Number | 1710257175
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Entity Type | Organization
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Legal Business Name | MAIDMAN-JOSHUA INC
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Dates
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Enumeration Date | 01/03/2012
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Last Update Date | 01/03/2012
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Provider Practice Location Address
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Address Line | 5200 WILLSON RD STE 150
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City | EDINA
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State | MN
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Zip | 55424-1300
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Country | US
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Telephone | 952-926-4554
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Fax | 952-836-2730
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Provider Business Mailing Address
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Address Line | 5200 WILLSON RD STE 150
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City | EDINA
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State | MN
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Zip | 55424-1300
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Country | US
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Telephone | 952-926-4554
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Fax | 952-836-2730
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. JANICE MADIMAN
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Credential | PSYD LP
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Telephone | 952-926-4554
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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 | LP1361
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License Number State | MN
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