Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | LP6187 | MN |
NPI | 1003277732 |
---|---|
Provider Name | Ia Xiong X Toyed |
First Address | Prior Lake, MN 55372-9228 |
Second Address | Prior Lake, MN 55372-9228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2016 |
Last Update Date | 17/01/2018 |