PHILLIP L. EDWARDSON (NPI# 1891862389) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891862389 |
| Entity Type | Individual |
| Full Name | PHILLIP L. EDWARDSON |
| Credential | M.D. |
| Practice Address |
3100 W Lake St Suite 210 Minneapolis MN 55416-4527 |
| Practice Telephone | 6129256033 |
| Mailing Telephone | 6129256033 |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2013-12-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
19329 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | MEDICAL ASSISTANCE | 830593500 | 01 |
| Street Address |
3100 W LAKE ST SUITE 210 |
| City | MINNEAPOLIS |
| State | MN |
| Zip Code | 55416-4527 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417957101 | Ronald James Frederick Jr. | Psychologist | 3100 W Lake St, Suite 107, Minneapolis, MN 55416-4527 | 2005-07-26 |
| 1235665761 | Nicole Massey | Marriage & Family Therapist | 3100 W Lake St, Suite 210, Minneapolis, MN 55416-4527 | 2017-05-03 |
| 1760923940 | Lynn Erika Penney | Counselor | 3100 W Lake St, Suite 210, Minneapolis, MN 55416-4527 | 2017-03-20 |
| 1629526405 | Ariel Brinson | Social Worker | 3100 W Lake St, Suite 210, Minneapolis, MN 55416-4527 | 2016-09-21 |
| 1952855918 | Roberta Ann Seelen-wolf | Registered Nurse | 3100 W Lake St, 210, Minneapolis, MN 55416-4527 | 2016-08-08 |
| 1619420817 | Julie Blatz | Social Worker | 3100 W Lake St, Suite 210, Minneapolis, MN 55416-4527 | 2016-07-25 |
| 1750736708 | Kiana Joyner | Social Worker | 3100 W Lake St, Suite 210, Minneapolis, MN 55416-4527 | 2016-04-27 |
| 1427415082 | Natalie Ann Tobeck | Social Worker | 3100 W Lake St, Suite 210, Minneapolis, MN 55416-4527 | 2016-01-26 |
| 1598132953 | Amanda J Ardolf | Counselor | 3100 W Lake St, Ste 210, Minneapolis, MN 55416-4527 | 2015-09-01 |
| 1578930293 | Leeann Catherine Lewis | Social Worker | 3100 W Lake St, Ste 210, Minneapolis, MN 55416-4527 | 2015-08-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639711492 | Ismahan Abdirahman Mohamed | Psychologist | 4236 Parkglen Rd, St Louis Park, MN 55416 | 2019-10-14 |
| 1598307860 | Ayman Abulaziz Mohamed | Counselor | 4326 Park Glen Rd, St Louis Park, MN 55416 | 2019-10-08 |
| 1831758929 | Ally Group Homes LLC | Assisted Living Facility | 2944 Princeton Ave South, Saint Louis Park, MN 55416 | 2019-06-11 |
| 1609371525 | Heather Margaret Flatgard | Chiropractor | 5407 Excelsior Blvd Ste D, St Louis Park, MN 55416 | 2018-03-25 |
| 1942702394 | Polaris Pharmacy Services of Minnesota, LLC | Pharmacy | 4220 Park Glen Road, St. Louis Park, MN 55416 | 2018-03-01 |
| 1316469760 | Evert Ray Boyd | Psychologist | 3200 Highway 100 S., Groves Academy, St Louis Park, MN 55416 | 2017-07-07 |
| 1861941684 | Amanda Marie Tapper | Marriage & Family Therapist | 5407 Excelsior Blvd, Suite B, St Louis Park, MN 55416 | 2016-09-22 |
| 1326410416 | Clear Health Chiropractic LLC | Chiropractor | 5614 W 36th St, St. Louis Park, MN 55416 | 2015-10-28 |
| 1568897833 | Kay Elizabeth Lichtenberger | Physical Therapist | 4415 W 36.5 St, St. Louis Park, MN 55416 | 2013-09-05 |
| 1710221510 | Aaron Christopher Oppelt | Counselor | 1665 Utica Ave South - Suite 100, Saint Louis Park, MN 55416 | 2012-11-16 |
| Find all providers in zip 55416 | ||||
| Taxonomy Code | 2084P0804X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Child & Adolescent Psychiatry |
| Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952945180 | Pathways Autism Center LLC | Psychiatry & Neurology | 2021 E Hennepin Ave Ste 155, Minneapolis, MN 55413-1772 | 2019-10-31 |
| 1831357219 | Lawrence John Young Jr. | Psychiatry & Neurology | 800 E 28th St, Ste. 600, Wasie Bldg., Minneapolis, MN 55407-3723 | 2008-06-02 |
| 1427144815 | Adam Fox | Psychiatry & Neurology | 15 Groveland Ter Ste 201, Minneapolis, MN 55403-1154 | 2006-10-05 |
| 1801836127 | Sanjiv Kumra | Psychiatry & Neurology | 2312 S 6th St, Suite F256/2b W, Minneapolis, MN 55454-1336 | 2006-06-07 |
| 1437566437 | Chiamaka Perditta Nwankiti | Psychiatry & Neurology | 2450 Riverside Ave South, Minneapolis, MN 55455 | 2014-07-22 |
| 1558776930 | Raghu Gandhi | Psychiatry & Neurology | 2450 Riverside Ave, Minneapolis, MN 55454-1450 | 2014-06-24 |
| 1235419631 | Narendran Mavinakayinahalli Neelakantachar | Psychiatry & Neurology | 2450 Riverside Ave, Minneapolis, MN 55454-1450 | 2011-08-17 |
| 1801100102 | Catherine Jordan Steingraeber | Psychiatry & Neurology | 2450 Riverside Ave, Minneapolis, MN 55454-1450 | 2010-07-29 |
| 1346484227 | Diana Marie Pandey | Psychiatry & Neurology | 800 E 28th St, Mr 12301, Minneapolis, MN 55407-3723 | 2009-04-23 |
| 1467507152 | William R Dikel | Psychiatry & Neurology | 1313 Penn Ave N, Minneapolis, MN 55411-3047 | 2007-01-24 |
| Find all providers in MINNEAPOLIS | ||||
| City | MINNEAPOLIS |
| Zip Code | 55416 |
Please comment or provide details below to improve the information on PHILLIP L. EDWARDSON.
| 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.