| NPI | 1104205319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH L. STAPLETON Owner, Operator 218-326-5694 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP3021) |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2025-09-15 |