Provider Demographics
NPI:1184283541
Name:PRACTICE PLACE, PLLC
Entity type:Organization
Organization Name:PRACTICE PLACE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERMAN
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:NORMANDIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:701-885-4551
Mailing Address - Street 1:2534 17TH AVE S STE E
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5215
Mailing Address - Country:US
Mailing Address - Phone:701-885-4551
Mailing Address - Fax:
Practice Address - Street 1:2534 17TH AVE S STE E
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-5215
Practice Address - Country:US
Practice Address - Phone:208-406-9794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1083630974Medicaid
ND1033210570Medicaid
ND1124128756Medicaid