Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | LP4022 | MN |
N | 103T00000X | Psychologist | LP4022 | MN |
N | 103G00000X | Clinical Psychologist | LP4022 | MN |
N | 103TC0700X | Clinical Psychologist | LP4022 | MN |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | LP4022 | MN |
N | 103TH0100X | Health Service | LP4022 | MN |
NPI | 1639282262 |
---|---|
Provider Name | Donna M Miliotis |
First Address | Roseville, MN 55113 |
Second Address | St Paul, MN 55102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 08/07/2007 |