Provider Demographics
NPI:1639831100
Name:PLASCH, CAROLYN THERESE
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:THERESE
Last Name:PLASCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 HARBOR LN N STE 200
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-5103
Mailing Address - Country:US
Mailing Address - Phone:612-445-8314
Mailing Address - Fax:800-513-7773
Practice Address - Street 1:1912 CLINTON AVE APT 108
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2755
Practice Address - Country:US
Practice Address - Phone:651-497-8332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician