Provider Demographics
NPI:1710257175
Name:MAIDMAN-JOSHUA INC
Entity Type:Organization
Organization Name:MAIDMAN-JOSHUA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MADIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD LP
Authorized Official - Phone:952-926-4554
Mailing Address - Street 1:5200 WILLSON RD STE 150
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1300
Mailing Address - Country:US
Mailing Address - Phone:952-926-4554
Mailing Address - Fax:952-836-2730
Practice Address - Street 1:5200 WILLSON RD STE 150
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1300
Practice Address - Country:US
Practice Address - Phone:952-926-4554
Practice Address - Fax:952-836-2730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1361103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1235276791OtherNPI
MN680001686Medicare UPIN