Amherst H. Wilder Foundation
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Saint Paul, MN
NPI 1548337355 · NPPES record last updated Oct 3, 2012
Key facts
- NPI
- 1548337355
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- AMHERST H. WILDER FOUNDATION
- Practice address
- 451 Lexington Pkwy N
Saint Paul, MN 55104-4636 - Phone
- (651) 280-2000
- Fax
- (651) 280-2310
- NPI assigned
- Nov 29, 2006
- Organization subpart
- No
Authorized official
- Name
- Morris Goodwin
- Title
- Vice President Administration
- Phone
- (651) 280-2310
Corporate family (same tax ID) 21
Practitioners 85
-
Saoirse M Edongnek, LICSW
-
Raksmey Grotte, LP
-
Stacie L Joncas, LP
-
Kyle Lipinski, MSS, LADC
-
Ka Lo, LICSW
-
Lisa M Morgan, LPCC
-
Bobbi-Jo Lisa Moujid, LICSW
-
Rosemary O'Brien, MA,LP
-
Jackson Friedrich Raynor, MSW, LICSW
-
Shoua Vang, LMFT
-
Joua Yang, LCSW
-
Amanda Louise Ament-Lemke, LICSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110526000442 | MN | Part B Supplier - Clinic/Group Practice | 0941288922 |
Receives reassigned benefits from 83 practitioners Practice locations: Saint Paul, MN |
National Provider Directory
- Tax ID family
- Senior Health Clinic
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Agency | 251B00000X | |||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes |
Addresses
Primary practice location
451 Lexington Pkwy N
Saint Paul, MN 55104-4636
Mailing address
451 Lexington Pkwy N
Saint Paul, MN 55104-4636
Phone (651) 280-2310
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 555055600 | Other | MN | MEDICAL ASSISTANCE |
Other providers in Saint Paul, MN
- Amherst H. Wilder Foundation
- Amherst H. Wilder Foundation
- Amherst H. Wilder Foundation
- Amherst H. Wilder Foundation
- Amherst H. Wilder Foundation
- Amherst H. Wilder Foundation
- Amherst H. Wilder Foundation
- Amherst H. Wilder Foundation
- Amherst H. Wilder Foundation
- Amherst H. Wilder Foundation
All providers in Saint Paul, MN · Mental Health Clinic/Center (Including Community Mental Health Center) in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.