Modahl, Edward C

Modahl, Edward C is an individual health care provider with primary practice located at 324 Broadway St Ste 206 , Alexandria MN 56308-1482. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Modahl, Edward C can be contacted via phone (320) 762-1762.

Contact Information

Primary practice address
324 Broadway St Ste 206 Alexandria MN 56308-1482
Phone: (320) 762-1762
Fax: (320) 762-0796
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X LP0834 Minnesota

Profile Details

NPI number 1831268812
LBN Legal business name Modahl, Edward C
Credentials MS ED LP
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 6th, 2006
Last updated May 6th, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1831268812 NPPES
Minnesota Other 218G3MO BLUE CROSS BLUE SHIELD
Minnesota Other 138070 BLUE CROSS BLUE SHIELD
Minnesota Other 571052900 BLUE CROSS BLUE SHIELD
Minnesota MEDICAID 571052900 BLUE CROSS BLUE SHIELD
Minnesota Other 6267221 BLUE CROSS BLUE SHIELD

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