| NPI | 1699943209 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD MICHAEL BOSL Clinical Director 320-257-1800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP2823) |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2020-10-28 |