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NPI Code Detail

MEDICARE: DR. BRIAN HOWARD ROSCOE PSYD LP

MEDICARE: DR. BRIAN HOWARD ROSCOE PSYD 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
1103T00000XPsychologistLP6431MN

General Provider Information

NPI Number : 1518488311
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRIAN HOWARD ROSCOE PSYD LP
Provider Business Mailing Address
First Line : 2925 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1321
Country : US
Telephone Number : 612-262-9000
Fax Number :
Provider Business Practice Location Address
First Line : 17489 DODD BLVD
Second Line :
City : LAKEVILLE
State : MN
Zip : 55044-6506
Country : US
Telephone Number : 952-428-1020
Fax Number : 952-428-1025
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2017
Last Update Date : 05/16/2024

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