Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | LP3347 | MN |
NPI | 1083748537 |
---|---|
Provider Name | Dr. Weston Michael Edwards |
First Address | Minneapolis, MN 55403-3251 |
Second Address | Minneapolis, MN 55403-3251 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 09/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6177516 | UBH (01) | |
635K4ED | BCBS (01) |