Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 5603 | MN |
Y | 103T00000X | Psychologist | 5603 | MN |
NPI | 1003037458 |
---|---|
Provider Name | Dr. Devon E. Whitehead |
First Address | Saint Cloud, MN 56303-2613 |
Second Address | Saint Cloud, MN 56303-2613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/04/2013 |