| NPI | 1093756041 |
|---|---|
| Other Name | STEPHANIE ANN UNTIEDT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: MN 4599) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MN 4599) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2015-02-01 |