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General NPI Number Information
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NPI Number | 1710393012
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Entity Type | Individual
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Provider Name | BRYCE MERRIMAN
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Gender | Male
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Dates
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Enumeration Date | 07/08/2014
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Last Update Date | 07/08/2014
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Provider Practice Location Address
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Address Line | 2060 CENTRE POINTE BLVD SUITE #3
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City | SAINT PAUL
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State | MN
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Zip | 55120-1269
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Country | US
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Telephone | 651-774-0011
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Fax | 651-774-0606
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Provider Business Mailing Address
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Address Line | 5530 ZEALAND AVE N
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City | MINNEAPOLIS
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State | MN
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Zip | 55428-3726
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Country | US
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Telephone | 612-226-2617
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 081880
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | AP14-1068
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License Number State | MN
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