| Cpgr | |
|
4317 Upton Ave S Ste A Minneapolis MN 55410-1540 | |
| (952) 222-8162 | |
| Not Available |
| Full Name | Cpgr |
|---|---|
| Speciality | Psychologist |
| Location | 4317 Upton Ave S Ste A, Minneapolis, Minnesota |
| Authorized Official Name and Position | Dennis Hannon (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 9522228162 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cpgr 4317 Upton Ave S Ste A Minneapolis MN 55410-1540 Ph: (952) 222-8162 | Cpgr 4317 Upton Ave S Ste A Minneapolis MN 55410-1540 Ph: (952) 222-8162 |
| NPI Number | 1003576653 |
|---|---|
| Provider Enumeration Date | 12/22/2021 |
| Last Update Date | 04/11/2024 |
| Certification Date | 04/11/2024 |
| Medicare PECOS PAC ID | 3072964782 |
|---|---|
| Medicare Enrollment ID | O20240108000354 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003576653 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Dennis F Hannon |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1447762869 PECOS PAC ID: 9032478441 Enrollment ID: I20180110002382 |
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