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1821571159
THARAKI SIYAGUNA
MOORHEAD, MN
NPI
1821571159
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
103TC0700X Psychologist, Clinical
(Licence: MN LP6711)
Additional Taxonomies
174400000X Specialist
Enumeration Date
2018-09-12
Last Update Date
2021-10-15
Business Address
THARAKI SIYAGUNA
1547 30TH AVE S
MOORHEAD, MN 56560-5055
Phone number: 218-287-4338
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Mailing Address
THARAKI SIYAGUNA
1547 30TH AVE S
MOORHEAD, MN 56560-5055
Phone number: 218-287-4338
Copy
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