Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | LP3820 | MN |
NPI | 1053434159 |
---|---|
Provider Name | Ms. Suzanne Gayle Wenstrom Pocrnich |
First Address | Cambridge, MN 55008-6016 |
Second Address | Cambridge, MN 55008-1552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 08/07/2007 |