MEDICARE: MR. THOMAS AARON RIDGE M.S.,L.P.,L.I.C.S.W.

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	103T00000X	Psychologist	LP2900	MN

General Provider Information

NPI Number	:	1912051780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS AARON RIDGE M.S.,L.P.,L.I.C.S.W.

Provider Business Mailing Address
First Line	:	1135 5TH ST NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-1301
Country	:	US
Telephone Number	:	612-379-8750
Fax Number	:	612-378-6025

Provider Business Practice Location Address
First Line	:	1135 5TH ST NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-1301
Country	:	US
Telephone Number	:	612-379-8750
Fax Number	:	612-378-6025

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/08/2007

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