| NPI | 1295950368 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP4789) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MN LP4789) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MN LP4789) | |
| 103TH0100X Psychologist Health Service (Licence: MN LP4789) | |
| 103TC1900X Psychologist Counseling (Licence: MN LP4789) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: MN LP4789) | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2014-11-09 |