| NPI | 1265867923 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIA KIDWELL Licensed Psychologist 763-566-0088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP5403) |
| Enumeration Date | 2013-09-12 |
| Last Update Date | 2014-06-18 |