Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | LP1178 | MN |
NPI | 1093936379 |
---|---|
Provider Name | Ms. Theresa Marie Voss |
First Address | Minneapolis, MN 55417-2432 |
Second Address | Saint Paul, MN 55114-1525 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104441 | PREFERRED ONE (01) | MN |
104441 | UCARE (01) | MN |
3H758VO AND 3H757VO | BLUE CROSS BLUE SHIELD (01) | MN |
6263293 | MEDICA (01) | MN |