| NPI | 1750090858 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GWEN PEDERSEN Marriage & Family Therapist 320-255-0343 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2022-11-16 |
| Last Update Date | 2024-02-20 |