Provider Demographics
NPI:1851106207
Name:POLSKI, MELISSA ROSEWALL (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ROSEWALL
Last Name:POLSKI
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:JEAN
Other - Last Name:ROSEWALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:5775 WAYZATA BLVD STE 255
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1275
Mailing Address - Country:US
Mailing Address - Phone:952-525-4500
Mailing Address - Fax:
Practice Address - Street 1:5775 WAYZATA BLVD STE 255
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1275
Practice Address - Country:US
Practice Address - Phone:952-525-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical