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NPI Code Detail

MEDICARE: DR. THERESA J BERNARD PSYD, LP

MEDICARE: DR. THERESA J BERNARD 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
1103T00000XPsychologistLP4565MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831264977
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THERESA J BERNARD PSYD, LP
Provider Business Mailing Address
First Line : 3705 15TH AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-2717
Country : US
Telephone Number : 612-729-7190
Fax Number :
Provider Business Practice Location Address
First Line : 4432 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-3519
Country : US
Telephone Number : 612-870-2453
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2006
Last Update Date : 04/02/2009

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