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1518132737
BRENDA LYNN DESTACHE
WOODBURY, MN
NPI
1518132737
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
103T00000X Psychologist
(Licence: MN LP2836)
Enumeration Date
2008-04-29
Last Update Date
2008-04-29
Business Address
-- BRENDA LYNN DESTACHE MSLP
1976 WOODALE DR
WOODBURY, MN 55125
Phone number: 651-730-8464
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Mailing Address
-- BRENDA LYNN DESTACHE MSLP
391 JESSE JAMES LN
MAHTOMEDI, MN 55115-1794
Phone number: 651-730-8464
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