MEDICARE: CONSTANCE MCLEOD HVASS PH.D.

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	LP1057	MN

General Provider Information

NPI Number	:	1437178738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSTANCE MCLEOD HVASS PH.D.

Provider Business Mailing Address
First Line	:	5225 HOLLY LN N
Second Line	:	#2
City	:	PLYMOUTH
State	:	MN
Zip	:	55446-1783
Country	:	US
Telephone Number	:	763-205-1641
Fax Number	:	612-342-2606

Provider Business Practice Location Address
First Line	:	2915 WAYZATA BLVD
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55405-2145
Country	:	US
Telephone Number	:	612-834-0424
Fax Number	:	612-342-2606

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	12/04/2009

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