Provider Demographics
NPI:1538179031
Name:BARNER, PEARL II (PHD)
Entity type:Individual
Prefix:DR
First Name:PEARL
Middle Name:
Last Name:BARNER
Suffix:II
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 S 7TH ST
Mailing Address - Street 2:SUITE 2402
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1821
Mailing Address - Country:US
Mailing Address - Phone:651-293-0163
Mailing Address - Fax:
Practice Address - Street 1:431 S 7TH ST
Practice Address - Street 2:SUITE 2402
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1821
Practice Address - Country:US
Practice Address - Phone:651-293-0163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0110103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN886250800Medicaid
MN680000405Medicare ID - Type Unspecified