| NPI | 1750654612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERI A WYLIE Clinical Psychologist 651-482-9361 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP3760) |
| Enumeration Date | 2012-02-22 |
| Last Update Date | 2012-02-22 |