| NPI | 1124398607 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN GUSTAFSON Psychologist 612-886-2524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP3594) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN LP3594) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: MN LP3594) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MN LP3594) | |
| 103TC1900X Psychologist, Counseling (Licence: MN LP3594) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MN LP3594) | |
| 103TS0200X Psychologist, School (Licence: MN LP3594) | |
| Enumeration Date | 2011-12-30 |
| Last Update Date | 2018-06-11 |