Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | LP3901 | MN |
NPI | 1104038660 |
---|---|
Provider Name | Rebecca Jane Anderson |
First Address | Golden Valley, MN 55422-5341 |
Second Address | Saint Louis Park, MN 55416-3049 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 08/07/2007 |