Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 2028 | AZ |
N | 103TC0700X | Clinical Psychologist | 2028 | AZ |
N | 102L00000X | Psychologist | 2028 | AZ |
N | 103T00000X | Psychologist | 2028 | AZ |
N | 102L00000X | Psychologist | 2514-057 | WI |
N | 103T00000X | Psychologist | 2514-057 | WI |
Y | 102L00000X | Psychologist | 4328 | MN |
Y | 103T00000X | Psychologist | 4328 | MN |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 4328 | MN |
N | 103TH0100X | Health Service | 4328 | MN |
N | 103TP2701X | Group Psychotherapist | 4328 | MN |
N | 103TR0400X | Rehabilitation Psychologist | 4328 | MN |
NPI | 1396859310 |
---|---|
Provider Name | Dr. Marsha Jeanne Fields |
First Address | Mankato, MN 56001-5066 |
Second Address | Mankato, MN 56001-5473 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 15/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0634280-00 | (05) | MN |
39147700 | (05) | WI |