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NPI Code Detail

MEDICARE: DR. KELSEY MARIE HYDE PSYD

MEDICARE: DR. KELSEY MARIE HYDE PSYD
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
1103TC0700XClinical PsychologistPSY.0005351CO
2103TC0700XClinical Psychologist6664MN

General Provider Information

NPI Number : 1962804773
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELSEY MARIE HYDE PSYD
Provider Business Mailing Address
First Line : PO BOX 51
Second Line :
City : VICTORIA
State : MN
Zip : 55386-0051
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1435 WHITE OAK DR STE 200
Second Line :
City : CHASKA
State : MN
Zip : 55318-2567
Country : US
Telephone Number : 952-443-4600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2014
Last Update Date : 03/19/2021

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