Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | LP 5405 | MN |
NPI | 1083999544 |
---|---|
Provider Name | Maria Kroupina |
First Address | Minneapolis, MN 55414-2959 |
Second Address | Minneapolis, MN 55454-1404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2011 |
Last Update Date | 17/10/2011 |