GREAT LAKES NEUROBEHAVIORAL CENTER, PC (NPI# 1649717778) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649717778 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES NEUROBEHAVIORAL CENTER, PC |
| Practice Address |
7373 France Ave S Suite 305 Edina MN 55435-4534 |
| Mailing Address |
10195 Inver Grove Trl Inver Grove Heights MN 55076-3830 |
| Practice Telephone | 6123827165 |
| Mailing Telephone | 6123827165 |
| Enumeration Date | 2017-01-27 |
| Last Update Date | 2017-03-03 |
| Authorized Official Name | DR. MELISSA FISCHER (NEUROPSYCHOLOGIST) |
| Authorized Official Telephone | 6123827165 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | 6005 | MN | Behavioral Health & Social Service Providers |
| Street Address |
7373 FRANCE AVE S SUITE 305 |
| City | EDINA |
| State | MN |
| Zip Code | 55435-4534 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700880754 | Steven F Noran | Psychiatry & Neurology | 7373 France Ave S, Ste 604, Edina, MN 55435-4552 | 2005-06-08 |
| 1851903124 | Lee Ward Schaefer | Psychologist | 7373 France Ave S, Edina, MN 55435-4451 | 2020-08-18 |
| 1558801357 | Tattoo Removal Shop | Emergency Medicine | 7373 France Ave S, Suite 504, Edina, MN 55435-4549 | 2017-02-28 |
| 1629401419 | Daniel Douglas Swatfager | Physical Therapist | 7373 France Ave S, Edina, MN 55435-4534 | 2013-08-15 |
| 1578901294 | Kelly Reed | Physical Therapist | 7373 France Ave S, Edina, MN 55435-4534 | 2013-06-05 |
| 1215372297 | Nirmal Kharel | Family Medicine | 7373 France Ave S, Suite 202, Edina, MN 55435-4534 | 2013-05-06 |
| 1851645071 | Sandra Jean Gress | Physical Therapist | 7373 France Ave S, Edina, MN 55435-4534 | 2012-11-09 |
| 1457608267 | Kristine Dahlheimer Alme | Physical Therapist | 7373 France Ave S, Edina, MN 55435-4534 | 2012-08-10 |
| 1235492059 | Bradley Marc Sundick | Dentist | 7373 France Ave S, Suite 602, Edina, MN 55435-4534 | 2012-06-18 |
| 1891055851 | Advanced Spine and Pain Clinics of Minnesota LLC | Anesthesiology | 7373 France Ave S, Suite 606, Edina, MN 55435-4534 | 2012-05-24 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104433416 | Evy Christine Claussen | Social Worker | 6363 France Ave. S., Edina, MN 55435 | 2020-09-30 |
| 1508496621 | Samantha Jean Mcgough Lamere | Physician Assistant | 4300 Marketpointe Drive, Suite 100, Bloomington, MN 55435 | 2020-01-16 |
| 1659920460 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 3408 Galleria, Edina, MN 55435 | 2019-09-05 |
| 1730651639 | Taylor Lee Kehoe | Physician Assistant | 7400 France Ave., Suite #100, Edina, MN 55435 | 2018-12-18 |
| 1538666326 | Amanda Deangelo | Physical Therapist | 6401 Southdale Hospital, Ll3g, Edina, MN 55435 | 2018-04-09 |
| 1982107876 | Julia Seliber | Dental Hygienist | 7600 France Ave.s. Suite 1100, Edina, MN 55435 | 2018-03-16 |
| 1154840064 | Southhealth Asc, LLC | Clinic/Center | 4100 Minnesota Drive, Edina, MN 55435 | 2017-09-12 |
| 1730605528 | Edina Medical Supplies | Durable Medical Equipment & Medical Supplies | 7455 France Ave., #614 S, Edina, MN 55435 | 2017-08-14 |
| 1033565510 | Minnesota Disc Replacement and Spine Restoration Center | Clinic/Center | 4444 76 St, #700, Edina, MN 55435 | 2016-05-13 |
| 1306206321 | Barb Ryan | Mechanotherapist | 7550 France Avenue S, #220, Edina, MN 55435 | 2016-03-03 |
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| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043704679 | Erin Ayala | Psychologist | 7401 Metro Blvd Ste 510, Edina, MN 55439-3033 | 2018-06-18 |
| 1538559810 | Krista Peterson | Psychologist | 6600 France Ave S Ste 230, Edina, MN 55435-1810 | 2015-01-26 |
| 1760899363 | Jl Norman, Inc | Psychologist | 7241 Ohms Ln Ste 145, Edina, MN 55439-2136 | 2014-07-15 |
| 1104158195 | Jan Hoistad | Psychologist | 4433 Dunham Dr, Edina, MN 55435-4139 | 2010-02-02 |
| 1093990798 | Iris H Cornelius | Psychologist | 7401 Metro Blvd, Suite 400, Edina, MN 55439-3041 | 2008-01-01 |
| 1396935219 | Michele Frances Dodds | Psychologist | 3948 West 50th St, #207, Edina, MN 55424 | 2007-07-26 |
| 1649485111 | Minneapolis Southwest Mental Health Clinic, Limited | Psychologist | 4010 W 65th St Ste 101, Edina, MN 55435-1724 | 2007-05-10 |
| 1184840092 | Loren Antone Hooyman | Psychologist | 3919 W 44th St, Suite 200, Edina, MN 55424-1032 | 2007-04-18 |
| 1114045481 | Denise Hanna Bisanz | Psychologist | 3919 W 44th, #200, Edina, MN 55424-1032 | 2007-03-26 |
| 1437282860 | Applied Behavioral Consultants, Inc. | Psychologist | 5275 Edina Industrial Blvd, #103, Edina, MN 55439-2918 | 2007-03-14 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.