MEDICARE: DR. MADALINE G. BARNES 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	LP3458	MN

Other Identifiers

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

General Provider Information

NPI Number	:	1912992447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MADALINE G. BARNES PH.D.

Provider Business Mailing Address
First Line	:	120 LABREE AVE S
Second Line	:
City	:	THIEF RIVER FALLS
State	:	MN
Zip	:	56701-2819
Country	:	US
Telephone Number	:	651-681-4356
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 LABREE AVE S
Second Line	:
City	:	THIEF RIVER FALLS
State	:	MN
Zip	:	56701-2819
Country	:	US
Telephone Number	:	651-681-4356
Fax Number	:

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	07/21/2022

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