Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | ||
Y | 103TC0700X | Clinical Psychologist | ||
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1184674046 |
---|---|
Provider Name | Dr. Stanley Carl Ferneyhough |
First Address | Forest Lake, MN 55025-2523 |
Second Address | Duluth, MN 55805-1952 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 06/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
431250300 | (05) | MN |