Provider Demographics
NPI:1811993553
Name:POLSFUSS, CRAIG (MA, LP, MSW)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:
Last Name:POLSFUSS
Suffix:
Gender:M
Credentials:MA, LP, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15552 DYNASTY WAY
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124
Mailing Address - Country:US
Mailing Address - Phone:612-730-4843
Mailing Address - Fax:651-344-8298
Practice Address - Street 1:15552 DYNASTY WAY
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7836
Practice Address - Country:US
Practice Address - Phone:612-730-4843
Practice Address - Fax:651-344-8298
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0620103T00000X
MN026881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN013848700Medicaid
MNR35630Medicare UPIN
MN013848700Medicaid