MEDICARE: BENJAMIN J MERKLING 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
1	101YM0800X	Mental Health Counselor	6340	MN
2	103TE1100X	Exercise & Sports Psychologist
3	103T00000X	Psychologist	6340	MN

General Provider Information

NPI Number	:	1972172088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN J MERKLING LP

Provider Business Mailing Address
First Line	:	7401 METRO BLVD
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55439-3025
Country	:	US
Telephone Number	:	651-353-5201
Fax Number	:

Provider Business Practice Location Address
First Line	:	7401 METRO BLVD
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55439-3025
Country	:	US
Telephone Number	:	651-353-5201
Fax Number	:

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

Provider Enumeration Date	:	06/22/2021
Last Update Date	:	06/22/2021

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