Provider Demographics
NPI:1073773651
Name:JOHN HONEBRINK
Entity Type:Organization
Organization Name:JOHN HONEBRINK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MEULEMANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-307-7865
Mailing Address - Street 1:1700 W HWY 36
Mailing Address - Street 2:210 ROSEDALE TOWERS
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:651-490-9920
Mailing Address - Fax:651-578-1125
Practice Address - Street 1:1700 W HWY 36
Practice Address - Street 2:210 ROSEDALE TOWERS
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113
Practice Address - Country:US
Practice Address - Phone:651-490-9920
Practice Address - Fax:651-578-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1354103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN173348600Medicaid
MN23870HOOtherBCBS
MN173348600Medicaid