| NPI | 1891884326 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZY ELLEN PETERSON Owner 651-698-4443 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2020-08-22 |