Provider Demographics
NPI:1316643554
Name:KNOW THYSELF, PLLC
Entity type:Organization
Organization Name:KNOW THYSELF, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAATZ
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:763-242-3261
Mailing Address - Street 1:417 RUCKS FARM RD
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-8837
Mailing Address - Country:US
Mailing Address - Phone:763-242-3261
Mailing Address - Fax:866-318-3073
Practice Address - Street 1:10505 WAYZATA BLVD STE 203-3
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1502
Practice Address - Country:US
Practice Address - Phone:763-242-3261
Practice Address - Fax:866-318-3073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1710295001Medicaid