Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | LP6589 | MN |
NPI | 1013524545 |
---|---|
Provider Name | Dr. Jennifer A. Waltman |
First Address | Minneapolis, MN 55405-2304 |
Second Address | Minneapolis, MN 55408-2620 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2020 |
Last Update Date | 29/09/2020 |