Individual
MICHELLE MILLENACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LP
Contact information
Practice address
3100 W LAKE ST, SUITE 210, MINNEAPOLIS, MN 55416-4527
(612) 925-6033
(612) 925-8496
Mailing address
3100 W LAKE ST, SUITE 210, MINNEAPOLIS, MN 55416-4527
(612) 925-6033
(612) 925-8496
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP4246
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
024L2MA
BCBS
MN
01
—
2028301
BHP
MN
01
—
6121476
MEDICA CHOICE
MN
01
—
HP34946
HEALTHPARTNERS
MN
01
—
P00261483
RR MEDICARE
MN
Enumeration date
11/29/2006
Last updated
07/08/2007
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