Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | LP1844 | MN |
NPI | 1063518306 |
---|---|
Provider Name | Ms. Gay Rosenthal |
First Address | Maple Grove, MN 55311 |
Second Address | Minneapolis, MN 55403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 08/07/2007 |