Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103G00000X | Clinical Psychologist | 300804 | MN |
N | 103TC0700X | Clinical Psychologist | 300804 | MN |
NPI | 1154603116 |
---|---|
Provider Name | Judy D Siems |
First Address | Minnetonka, MN 55305-2149 |
Second Address | Minnetonka, MN 55305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2011 |
Last Update Date | 15/09/2011 |