| NPI | 1073098810 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA M PAQUET Clinic Operations Manager 651-379-3443 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Enumeration Date | 2018-09-27 |
| Last Update Date | 2018-09-27 |