| NPI | 1609214311 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN E NICOL Clinical Psychologist 952-929-9478 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MN LP0182) |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2013-06-05 |