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NPI Code Detail

MEDICARE: PORT OF CROW WING COUNTY, INC

MEDICARE: PORT OF CROW WING COUNTY, INC
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
1103TB0200XCognitive & Behavioral Psychologist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1059T5POOTHERMNBLUECROSS BLUESHIELD
262-764-39OTHERMNUNITED BEHAVORIAL HEALTH
3131919OTHERMNU CARE
482364OTHERMNHEALTH PARTNERS
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
634B87POOTHERMNBLUECROSS BLUESHIELD

General Provider Information

NPI Number : 1205904612
Entity Type Code : Organization
Provider Name (Legal Business Name) : PORT OF CROW WING COUNTY, INC
Provider Business Mailing Address
First Line : PO BOX 367
Second Line :
City : LITTLE FALLS
State : MN
Zip : 56345-0367
Country : US
Telephone Number : 320-632-6647
Fax Number : 320-639-0014
Provider Business Practice Location Address
First Line : 1906 5TH AVE SE
Second Line :
City : LITTLE FALLS
State : MN
Zip : 56345-3317
Country : US
Telephone Number : 320-632-6647
Fax Number : 320-632-9525
Authorized Official
Title or Position : CREDENTIALING MANAGER
Name : MS. AMY HAIDER
Credential :
Telephone Number : 320-639-1425
Provider Enumeration Date : 12/01/2006
Last Update Date : 05/20/2022

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Directions to “PORT OF CROW WING COUNTY, INC ” Practice Location

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