Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 522 | ND |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | LP6251 | MN |
NPI | 1053785691 |
---|---|
Provider Name | Brianne M Marion |
First Address | Woodbury, MN 55125-2471 |
Second Address | Woodbury, MN 55125-2471 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2015 |
Last Update Date | 11/03/2020 |