Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 300771 | MN |
NPI | 1235240284 |
---|---|
Provider Name | Mrs. Ann Virginia Hobbick |
First Address | Anoka, MN 55303 |
Second Address | Fridley, MN 55432 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |