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Individual

MRS. ARDITH ANN MESSICCI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MA LP

Contact information

Practice address
13700 83RD WAY, SUITE 205, MAPLE GROVE, MN 55369-7015
(763) 494-8699
(763) 494-8797
Mailing address
3724 AUGER AVE, WHITE BEAR LAKE, MN 55110-4617
(541) 429-1326
(763) 494-8797

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP0951
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1012797
PREF 1
MN
01
3H756ME
BC BS
MN
01
6229932
UBH MEDICA
01
PS1226
AMERICAS PPO
Enumeration date
11/20/2006
Last updated
07/08/2007
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