MEDICARE: MS. THERESA MARIE VOSS M.A., L.P.

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	103TC1900X	Counseling Psychologist	LP1178	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	104441	OTHER	MN	UCARE
2	3H758VO AND 3H757VO	OTHER	MN	BLUE CROSS BLUE SHIELD
3	6263293	OTHER	MN	MEDICA
4	104441	OTHER	MN	PREFERRED ONE

General Provider Information

NPI Number	:	1093936379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. THERESA MARIE VOSS M.A., L.P.

Provider Business Mailing Address
First Line	:	5415 COLUMBUS AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55417-2432
Country	:	US
Telephone Number	:	612-823-1203
Fax Number	:

Provider Business Practice Location Address
First Line	:	821 RAYMOND AVE STE 100
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1525
Country	:	US
Telephone Number	:	651-251-0369
Fax Number	:	651-251-3072

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/09/2007

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