Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | LP5410 | MN |
NPI | 1306175443 |
---|---|
Provider Name | Dr. Jason Dean Reed |
First Address | St Louis Park, MN 55416-1603 |
Second Address | St Louis Park, MN 55416-5275 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2009 |
Last Update Date | 30/08/2016 |