Provider Demographics
NPI:1578661534
Name:GANJE-FLING, MARILYN ANNE (MA,LP)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:ANNE
Last Name:GANJE-FLING
Suffix:
Gender:F
Credentials:MA,LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4839 COLFAX AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-5319
Mailing Address - Country:US
Mailing Address - Phone:952-929-1905
Mailing Address - Fax:952-929-1771
Practice Address - Street 1:4500 PARK GLEN RD
Practice Address - Street 2:SUITE 350
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4871
Practice Address - Country:US
Practice Address - Phone:952-929-1905
Practice Address - Fax:952-929-1771
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1330103T00000X
103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN522K7GAOtherBLUE CROSS BLUE SHIELD
62-54592OtherMEDICA