Provider Demographics
NPI:1093936379
Name:VOSS, THERESA MARIE (MA, LP)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:MARIE
Last Name:VOSS
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5415 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2432
Mailing Address - Country:US
Mailing Address - Phone:612-823-1203
Mailing Address - Fax:
Practice Address - Street 1:821 RAYMOND AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1525
Practice Address - Country:US
Practice Address - Phone:651-251-0369
Practice Address - Fax:651-251-3072
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1178103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN104441OtherUCARE
MN3H758VO AND 3H757VOOtherBLUE CROSS BLUE SHIELD
MN6263293OtherMEDICA
MN104441OtherPREFERRED ONE