| NPI | 1447651062 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN BALLARD Owner 612-239-8166 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MN LP5288) |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2014-09-15 |