MEDICARE: VIRGINIA G EHRMAN LP

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	106H00000X	Marriage & Family Therapist	LP4121	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7445747	OTHER	MN	AENTA
2	62-42808	OTHER	MN	UBH
3	254L5EH	OTHER	FM	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1285791384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA G EHRMAN LP

Provider Business Mailing Address
First Line	:	4065 SIBLEY AVENUE
Second Line	:
City	:	DEEP HAVEN
State	:	MN
Zip	:	55391
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 WATER ST
Second Line	:
City	:	EXCELSIOR
State	:	MN
Zip	:	55331-1846
Country	:	US
Telephone Number	:	612-701-6488
Fax Number	:

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/08/2007

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