Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | LP1267 | MN |
Y | 103TC0700X | Clinical Psychologist | LP1267 | MN |
NPI | 1003917022 |
---|---|
Provider Name | Linda Louise Miller |
First Address | North St Paul, MN 55109-2496 |
Second Address | Shakopee, MN 55379-2666 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |