Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist |
NPI | 1225628217 |
---|---|
Provider Name | Ms. Ashley Nicole Cermak |
First Address | Corcoran, MN 55340-4443 |
Second Address | Medina, MN 55340-9535 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2021 |
Last Update Date | 22/01/2021 |