Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | LP4458 | MN |
N | 103T00000X | Psychologist | LP4458 | MN |
N | 103TB0200X | Cognitive & Behavioral Psychologist | LP4458 | MN |
N | 103G00000X | Clinical Psychologist | LP4458 | MN |
N | 103TC0700X | Clinical Psychologist | LP4458 | MN |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | LP4458 | MN |
N | 103TF0000X | Family Psychologist | LP4458 | MN |
N | 103TH0100X | Health Service | LP4458 | MN |
N | 103TR0400X | Rehabilitation Psychologist | LP4458 | MN |
NPI | 1326105610 |
---|---|
Provider Name | Karen Lynn Miller |
First Address | Plymouth, MN 55446-2199 |
Second Address | Minneapolis, MN 55414-3325 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 08/07/2007 |