| NPI | 1225199953 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZANNE E ERICKSON Office Administrator 952-404-9124 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 13015) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 829) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2020-08-22 |