| NPI | 1184774622 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARON STATON Executive Director 218-233-3991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN 245 B-CR) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2008-03-07 |