Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | CC01538 | MN |
NPI | 1063781771 |
---|---|
Provider Name | Dr. Julie Ann Gomer |
First Address | Maple Grove, MN 55311 |
Second Address | Maple Grove, MN 55311-4548 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2011 |
Last Update Date | 08/08/2017 |