Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | 179584 | MN |
NPI | 1194034579 |
---|---|
Provider Name | Mandie Bolton Kender |
First Address | Minneapolis, MN 55401 |
Second Address | West Saint Paul, MN 55118-3912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2010 |
Last Update Date | 01/10/2010 |