Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 101822 | MN |
N | 225XM0800X | Mental Health | 101822 | MN |
NPI | 1952662843 |
---|---|
Provider Name | Jessica Ann Engman |
First Address | White Bear Lake, MN 55110-6477 |
Second Address | White Bear Lake, MN 55110-6477 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2012 |
Last Update Date | 08/08/2016 |