Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | LP4030 | MN |
Y | 103T00000X | Psychologist | LP4030 | MN |
NPI | 1013002583 |
---|---|
Provider Name | Miss Michael Ward |
First Address | Inver Grove Heights, MN 55076 |
Second Address | Inver Grove Heights, MN 55076 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
126297 | BEHAVIORAL HEALTHCARE PRO (01) | MN |
62-35919 | UBH - MEDICA (01) | MN |
92D71WA | BLU3E CROSS BLUE SHIELD (01) | MN |