Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | MN | |
N | 101YS0200X | School Counselor | 476597 | MN |
NPI | 1124535349 |
---|---|
Provider Name | Mrs. Deanin Savon Willsun |
First Address | Shakopee, MN 55379-4439 |
Second Address | Brooklyn Center, MN 55429-3072 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2018 |
Last Update Date | 09/01/2018 |