MEDICARE: GOLDFINCH NEUROBEHAVIORAL SERVICES, LLC

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	103TC0700X	Clinical Psychologist
2	103G00000X	Clinical Neuropsychologist

General Provider Information

NPI Number	:	1083220602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDFINCH NEUROBEHAVIORAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	6640 SHADY OAK RD STE 375
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-7834
Country	:	US
Telephone Number	:	952-236-1267
Fax Number	:	952-236-4799

Provider Business Practice Location Address
First Line	:	6640 SHADY OAK RD STE 375
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-7834
Country	:	US
Telephone Number	:	952-236-1267
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHERYL PLEISS
Credential	:	PHD, LP
Telephone Number	:	952-236-1267

Provider Enumeration Date	:	09/18/2020
Last Update Date	:	10/27/2020

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