Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | LP5061 | MN |
Y | 103T00000X | Psychologist | LP5061 | MN |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | LP5061 | MN |
NPI | 1114138724 |
---|---|
Provider Name | Ms. Ingrid Dawn Meyer |
First Address | Minneapolis, MN 55407-3221 |
Second Address | Minnetonka, MN 55305-2009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 14/05/2009 |