is a Forensic in Sauk Rapids, Minnesota. practices all healthcare services and medical treatments related to Forensic. The NPI Number for is 1356452163. The last update date is .
's current location address is 225 N Benton Dr, Sauk Rapids, Minnesota. You can contact this provider via phone number 3206549311 and fax number 3206549248. The mailing address for is 225 N Benton Dr, Sauk Rapids, Minnesota. To know further, please read the information below!
Provider Profile Detail
Provider Name | |
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Address | 225 N Benton Dr, Sauk Rapids, Minnesota |
Phone Number | 3206549311 |
Fax Number | 3206549248 |
Sole Proprietor | -- |
Credentials | -- |
NPI Number Detail
NPI Number | 1356452163 |
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Provider Enumeration Date | |
Last Updated Date |
Provider Mailing Address Detail
Address | 225 N Benton Dr |
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City | Sauk Rapids |
State | Minnesota (MN) |
Post Code | 563791575 |
Phone Number | 3206549311 |
Fax Number | 3206549248 |
Provider's Primary Taxonomy Detail
Speciality | Forensic |
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Taxonomy | 103Tf0200X |
Licence No | LP 0251 |
Definition: A psychologist whose specialty is characterized by activities primarily intended to provide professional psychological expertise within the judicial and legal systems. |
Provider's Other Legacy Identifiers
Identifier | Identifier Type | Identifier State | Identifier Issuer |
---|---|---|---|
61-21170 | MN | MEDICA PIN | |
075J1TI 075J6T | MN | BCBS PROVIDER PIN |
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