Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | LP1890 | MN |
N | 103T00000X | Psychologist | LP1890 | MN |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | LP1890 | MN |
N | 103TA0700X | Adult Development & Aging Psychologist | LP1890 | MN |
N | 103TB0200X | Cognitive & Behavioral Psychologist | LP1890 | MN |
N | 103G00000X | Clinical Psychologist | LP1890 | MN |
N | 103TC0700X | Clinical Psychologist | LP1890 | MN |
N | 103TC1900X | Counseling Psychologist | LP1890 | MN |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | LP1890 | MN |
N | 103TE1100X | Exercise & Sports Psychologist | LP1890 | MN |
N | 103TF0000X | Family Psychologist | LP1890 | MN |
N | 103TF0200X | Forensic Psychologist | LP1890 | MN |
N | 103TH0004X | Health Psychologist | LP1890 | MN |
N | 103TM1800X | Intellectual & Developmental Disabilities | LP1890 | MN |
N | 103TP2701X | Group Psychotherapist | LP1890 | MN |
NPI | 1043426836 |
---|---|
Provider Name | Raymond John Knutson |
First Address | Saint Peter, MN 56082-2527 |
Second Address | Saint Peter, MN 56082-2527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 09/07/2007 |