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1851106207 NPI number — MELISSA ROSEWALL POLSKI MSW, LICSW

NPI Number: 1851106207
Health Care Provider/Practitioner: MELISSA ROSEWALL POLSKI MSW, LICSW

Information about “1851106207” NPI (MELISSA ROSEWALL POLSKI MSW, LICSW) exists in 1851106207 in HTML format HTML  |  1851106207 in plain Text format TXT  |  1851106207 in PDF (Portable Document Format) PDF  |  1851106207 in an XML format XML  formats.

NPI Number : 1851106207 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1851106207",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "POLSKI",
    "FirstName": "MELISSA",
    "MiddleName": "ROSEWALL",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MSW, LICSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ROSEWALL",
    "OtherFirstName": "MELISSA",
    "OtherMiddleName": "JEAN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MSW, LICSW",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "5775 WAYZATA BLVD STE 255",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ST LOUIS PARK",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55416-1275",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "952-525-4500",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5775 WAYZATA BLVD STE 255",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ST LOUIS PARK",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55416-1275",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "952-525-4500",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/12/2025",
    "LastUpdateDate": "02/12/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "30162",
        "LicenseNumberStateCode": "MN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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