| NPI | 1508174681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA J DEMOTTE Owner/Provider 952-891-2525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 05559) |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2010-12-21 |