MEDICARE: ASHLEE SECORD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor
2	106H00000X	Marriage & Family Therapist	1971	MN
3	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1073902177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASHLEE SECORD

Provider Business Mailing Address
First Line	:	11990 PORTLAND AVE
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-1516
Country	:	US
Telephone Number	:	612-568-6050
Fax Number	:	952-736-8375

Provider Business Practice Location Address
First Line	:	11990 PORTLAND AVE
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-1516
Country	:	US
Telephone Number	:	612-568-6050
Fax Number	:	952-736-8375

Authorized Official
Title or Position	:	OWNER
Name	:	ASHLEE NOEL SECORD
Credential	:
Telephone Number	:	612-568-6050

Provider Enumeration Date	:	01/13/2015
Last Update Date	:	07/15/2022

Similar Medicare Providers

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Practice Location Address:

11986 PORTLAND AVE
BURNSVILLE, MN
55337-1516

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Practice Fax:

1295712495 — DR. MICHELLE A BROUILLETTE PHD, LP
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1275593949 — MRS. SHARON JOYCE PETERSEN L.M.F.T.
Practice Location Address:

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55337-1516

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1033285093 — DR. STEPHEN ALEXANDER IRESTONE D.C., N.D.
Practice Location Address:

11970 PORTLAND AVE
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1659516888 — ASHLEE NOEL SECORD M.A., LMFT
Practice Location Address:

11990 PORTLAND AVE
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55337-1516

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Practice Fax: 952-479-7896

1407124225 — DR. STEPHEN A. IRESTONE, PA.
Practice Location Address:

11970 PORTLAND AVE
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55337-1516

Practice Phone: 952-895-7270
Practice Fax: 952-895-1086

Directions to “ASHLEE SECORD ” Practice Location

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