Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | LP0171 | MN |
Y | 103T00000X | Psychologist | LP0171 | MN |
NPI | 1003955410 |
---|---|
Provider Name | Douglas A Lewandowski |
First Address | Bemidji, MN 56601-8602 |
Second Address | Bemidji, MN 56601-8602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 08/07/2007 |