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NPI Code Detail

MEDICARE: CRAIG CARLSON LP

MEDICARE: CRAIG CARLSON 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
1103T00000XPsychologistLP3482MN

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 : 1841400579
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRAIG CARLSON LP
Provider Business Mailing Address
First Line : 1900 SILVER LAKE RD NW
Second Line :
City : NEW BRIGHTON
State : MN
Zip : 55112-1786
Country : US
Telephone Number : 651-628-9566
Fax Number : 651-628-0411
Provider Business Practice Location Address
First Line : 13100 WAYZATA BLVD STE 200
Second Line :
City : MINNETONKA
State : MN
Zip : 55305-1810
Country : US
Telephone Number : 952-206-2040
Fax Number : 952-206-2041
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 05/07/2019

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Directions to “ CRAIG CARLSON LP” Practice Location

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