Active NPI
Paul Luke Mladnick, LMFT
- Marriage & Family Therapist
- Forest Lake, MN
National Provider Identifier
1487843355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 1306
- Practice address
- 1068 So Lake St
#109
Forest Lake, MN 55025 - Phone
- (612) 719-7966
- Fax
- (651) 982-6035
- NPI assigned
- Oct 17, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 1306 | MN | Primary |
Addresses
Primary practice location
1068 So Lake St
#109
Forest Lake, MN 55025
Mailing address
1068 So Lake St
Suite 109
Forest Lake, MN 55025
Phone (612) 719-7966
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Marriage and Family Therapist
- Education
- Other, 1982
- Medicare assignment
- May accept Medicare assignment
- Group practices
Practice addresses (Care Compare)
1068 Lake St S
Suite 109
Forest Lake, MN 55025-2633
Phone (651) 982-4792
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Social Worker
- Forest Lake, MN
- NPI 1801929914
-
- Marriage & Family Therapist
- Forest Lake, MN
- NPI 1467219089
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192579200000",
"number": "1487843355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1068 SO LAKE ST",
"address_2": "SUITE 109",
"city": "FOREST LAKE",
"state": "MN",
"postal_code": "55025",
"telephone_number": "612-719-7966"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1068 SO LAKE ST",
"address_2": "#109",
"city": "FOREST LAKE",
"state": "MN",
"postal_code": "55025",
"telephone_number": "612-719-7966",
"fax_number": "651-982-6035"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MLADNICK",
"first_name": "PAUL",
"middle_name": "LUKE",
"name_prefix": "Mr.",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-10-17",
"last_updated": "2007-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "MN",
"license": "1306",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Forest Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.