Provider Demographics
NPI:1154566057
Name:PLASCH, STEPHEN (PSYD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:PLASCH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 METRO BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2316
Mailing Address - Country:US
Mailing Address - Phone:952-955-4714
Mailing Address - Fax:952-209-7396
Practice Address - Street 1:7400 METRO BLVD STE 205
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2316
Practice Address - Country:US
Practice Address - Phone:952-955-4714
Practice Address - Fax:952-209-7396
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5128103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical