MEDICARE: ADHD&U

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	103TC0700X	Clinical Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LP4497	OTHER	MN	BOARD OF PSYCHOLOGY

General Provider Information

NPI Number	:	1184240103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADHD&U

Provider Business Mailing Address
First Line	:	2196 CARTER AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55108-1709
Country	:	US
Telephone Number	:	651-675-6273
Fax Number	:

Provider Business Practice Location Address
First Line	:	2196 CARTER AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55108-1709
Country	:	US
Telephone Number	:	651-675-6273
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL PSYCHOLOGIST
Name	:	KATHERINE QUIE
Credential	:	PHD, L.P.
Telephone Number	:	651-675-6273

Provider Enumeration Date	:	06/25/2020
Last Update Date	:	06/25/2020

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Directions to “ADHD&U ” Practice Location

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