Provider Demographics
NPI:1508635368
Name:VISCERALIZATIONS PLLC
Entity Type:Organization
Organization Name:VISCERALIZATIONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIEF MANAGER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUCHMAN FALK
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-940-2136
Mailing Address - Street 1:7400 METRO BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2321
Mailing Address - Country:US
Mailing Address - Phone:612-940-2136
Mailing Address - Fax:
Practice Address - Street 1:7400 METRO BLVD STE 211
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2321
Practice Address - Country:US
Practice Address - Phone:612-940-2136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1750845244Medicaid