| NPI | 1396714234 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN MARIE KAVANAUGH President 952-893-9791 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP2468) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2014-06-03 |