| NPI | 1043375041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY JEANNE VAN ZILE Psychologist 612-558-4318 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LPO319) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MN LP0319) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MN LPO319) | |
| 103TC0700X Psychologist, Clinical (Licence: MS LP0319) | |
| 103TC1900X Psychologist, Counseling (Licence: MN LP0319) | |
| 103TF0000X Psychologist, Family (Licence: MN LP0319) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MS LP0319) | |
| 103T00000X Psychologist (Licence: MN LP0319) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2020-08-22 |