MEDICARE: ANOTHER STEP FORWARD LLC

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

General Provider Information

NPI Number	:	1396604039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANOTHER STEP FORWARD LLC

Provider Business Mailing Address
First Line	:	1803 BRYANT AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-3212
Country	:	US
Telephone Number	:	651-802-5867
Fax Number	:

Provider Business Practice Location Address
First Line	:	1803 BRYANT AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-3212
Country	:	US
Telephone Number	:	612-760-0542
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KELLEY PATRICIA MARTIN
Credential	:
Telephone Number	:	651-802-5867

Provider Enumeration Date	:	01/19/2026
Last Update Date	:	01/19/2026

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Directions to “ANOTHER STEP FORWARD LLC ” Practice Location

Language	Start Address	Practice Location

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