| Vian M Gredvig | |
|
1001 Twelve Oaks Center Dr Ste 1030d Wayzata MN 55391-4320 | |
| (952) 224-4862 | |
| (952) 224-4862 |
| Full Name | Vian M Gredvig |
|---|---|
| Speciality | Social Worker |
| Location | 1001 Twelve Oaks Center Dr Ste 1030d, Wayzata, Minnesota |
| Authorized Official Name and Position | Vian Maureen Gredvig (SOLE OWNER AND PROVIDER) |
| Authorized Official Contact | 9522244862 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vian M Gredvig 10217 Crestridge Dr Minnetonka MN 55305-1605 Ph: (952) 412-4490 | Vian M Gredvig 1001 Twelve Oaks Center Dr Ste 1030d Wayzata MN 55391-4320 Ph: (952) 224-4862 |
| NPI Number | 1942683669 |
|---|---|
| Provider Enumeration Date | 06/30/2015 |
| Last Update Date | 02/04/2023 |
| Certification Date | 02/04/2023 |
| Medicare PECOS PAC ID | 9032424163 |
|---|---|
| Medicare Enrollment ID | O20150818004845 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942683669 | NPI | - | NPPES |
| 1942246806 | Other | MN | NPI 1 |
| 1942683669 | Other | MN | NPI 2 |
| 1942683669 | Medicaid | MN | |
| 1942246806 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 6577 (Minnesota) | Primary |
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