Individual
DR. CELESTE ROSE YANISCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
3570 LEXINGTON AVE N, SUITE 100, SHOREVIEW, MN 55126-8049
(651) 481-0664
Mailing address
1596 UPPER AFTON RD, SAINT PAUL, MN 55106-6839
(651) 772-2577
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP3761
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
79G96YA
BCBSMN
MN
01
—
941419300
MEDICAL ASSISTANCE NUMBER
MN
01
—
HP46412
HEALTHPARTNERS NUMBER
MN
Enumeration date
03/07/2007
Last updated
07/08/2007
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