Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | LP5419 | MN |
N | 103TC0700X | Clinical Psychologist | LP5419 | MN |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | LP 5419 | MN |
NPI | 1033486964 |
---|---|
Provider Name | Julia Louise Conkel Ziebell |
First Address | Oakdale, MN 55128-3937 |
Second Address | Oakdale, MN 55128-3937 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2011 |
Last Update Date | 21/11/2011 |