Organization
MERRIAM PARK PSYCHOLOGICAL SERVICES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALISON C MAULE-KRONMILLER (PSYCHOLOGIST)
(651) 647-5722
Entity
Organization
Contact information
Practice address
1678 SELBY AVENUE, ST. PAUL, MN 55104
(651) 647-5722
(651) 647-5723
Mailing address
1678 SELBY AVENUE, ST. PAUL, MN 55104
(651) 647-5722
(651) 647-5723
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01H82MA
BCBS GROUP PROVIDER #
MN
01
—
01H83MA
BCBS IND. PROVIDER #
MN
01
—
1016735
PREFERRED ONE
MN
01
—
107019
UCARE
MN
01
—
6126079
UBH
MN
01
—
826823100
MEDICAL ASSISTANCE
MN
Enumeration date
05/04/2007
Last updated
05/26/2010
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