MEDICARE: DR. EMILY GRAESSER PSYD

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1336551506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMILY GRAESSER PSYD

Provider Business Mailing Address
First Line	:	2739 BUCHANAN ST NE APT 1
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-3037
Country	:	US
Telephone Number	:	802-299-8577
Fax Number	:

Provider Business Practice Location Address
First Line	:	2324 UNIVERSITY AVE W
Second Line	:	SUITE 120
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1843
Country	:	US
Telephone Number	:	651-644-4100
Fax Number	:

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

Provider Enumeration Date	:	05/22/2014
Last Update Date	:	05/22/2014

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