| NPI | 1356525513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOYCE TABORN JACKSON Vice Pres./Licensed Psychologist 612-338-9012 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP2524) |
| Enumeration Date | 2007-12-24 |
| Last Update Date | 2007-12-24 |