MEDICARE: DR. JAMES K MOSHER PHD

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	019156	NY
2	103TC0700X	Clinical Psychologist	6301019263	MI
3	103TC0700X	Clinical Psychologist	LP6039	MN

General Provider Information

NPI Number	:	1336217454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES K MOSHER PHD

Provider Business Mailing Address
First Line	:	900 AMERICAN BLVD E STE 212
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55420-1393
Country	:	US
Telephone Number	:	612-238-8988
Fax Number	:	612-677-3099

Provider Business Practice Location Address
First Line	:	900 AMERICAN BLVD E STE 212
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55420-1393
Country	:	US
Telephone Number	:	612-357-7723
Fax Number	:	612-677-3099

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	11/25/2025

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