Individual
MARCY VAN FOSSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
66 E 3RD ST, 201, WINONA, MN 55987-3478
(507) 452-7292
(507) 457-9887
Mailing address
66 E 3RD ST, 201, WINONA, MN 55987-3478
(507) 452-7292
(507) 457-9887
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP4392
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135853
—
MN
01
—
731291045880
PREFERRED ONE
MN
01
—
975T1VA
BCBS-MN
MN
01
—
HP55644
HEALTHPARTNERS
MN
Enumeration date
01/17/2007
Last updated
10/16/2007
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