| NPI | 1770630766 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER E COLE SHEPARD Rcm Mgr 763-330-5258 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149007794) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2024-10-22 |