Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | MN | |
Y | 103T00000X | Psychologist | MN |
NPI | 1013523299 |
---|---|
Provider Name | Rory Feeney |
First Address | Stillwater, MN 55082-5580 |
Second Address | Saint Paul, MN 55102-2424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2020 |
Last Update Date | 22/09/2020 |