| NPI | 1104128156 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY LUNDQUIST Administrative Director 800-246-9036 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MN A470016300) |
| Enumeration Date | 2010-11-24 |
| Last Update Date | 2010-11-24 |