| Port Of Crow Wing County, Inc | |
|
1906 5th Ave Se Little Falls MN 56345-3317 | |
| (320) 632-6647 | |
| (320) 632-9525 |
| Full Name | Port Of Crow Wing County, Inc |
|---|---|
| Speciality | Psychologist - Cognitive & Behavioral |
| Location | 1906 5th Ave Se, Little Falls, Minnesota |
| Authorized Official Name and Position | Amy Haider (CREDENTIALING MANAGER) |
| Authorized Official Contact | 3206391425 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Port Of Crow Wing County, Inc Po Box 367 Little Falls MN 56345-0367 Ph: (320) 632-6647 | Port Of Crow Wing County, Inc 1906 5th Ave Se Little Falls MN 56345-3317 Ph: (320) 632-6647 |
| NPI Number | 1205904612 |
|---|---|
| Provider Enumeration Date | 12/01/2006 |
| Last Update Date | 05/20/2022 |
| Certification Date | 05/20/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205904612 | NPI | - | NPPES |
| 059T5PO | Other | MN | BLUECROSS BLUESHIELD |
| 62-764-39 | Other | MN | UNITED BEHAVORIAL HEALTH |
| 131919 | Other | MN | U CARE |
| 82364 | Other | MN | HEALTH PARTNERS |
| 006031300 | Medicaid | MN | |
| 34B87PO | Other | MN | BLUECROSS BLUESHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TB0200X | Psychologist - Cognitive & Behavioral | (* (Not Available)) | Primary |
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