| NPI | 1770696726 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELYN K. WIERSMA Chief Manager 952-938-9499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP1583) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2017-04-05 |