Michael Dana Paulson, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP0989 Issued in MN

Practice address

891 Belsly Blvd
Moorhead, MN 56560-5055

Phone

(218) 287-4338

Fax

(218) 287-5928

NPI assigned

Aug 9, 2006

Last updated

Jun 17, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213660800000",
    "number": "1831109818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "891 BELSLY BLVD",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565605055",
            "telephone_number": "218-287-4338",
            "fax_number": "218-287-5928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "891 BELSLY BLVD",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565605055",
            "telephone_number": "218-287-4338",
            "fax_number": "218-287-5928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAULSON",
        "first_name": "MICHAEL",
        "middle_name": "DANA",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2008-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ND",
            "license": "39",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP0989",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCND",
            "identifier": "16069",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10716",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCMN",
            "identifier": "67D82PA",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephanie Leigh Palanuk, RN
• Katie Palloch
• Madison Paul
• Nancy A Paul, MS CCCSLP
• Sandra Kay Paul, MA/CCC-SLP
• Brittany Paulus
• Tausha May Pearson
• William O. Pearson IV, LAMFT
• Hannah Marie Pederson
• Kelsi Pederson

• Clinical Psychologist in Moorhead, MN
• Providers in Moorhead, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.