Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | LP0107 | MN |
NPI | 1023114048 |
---|---|
Provider Name | Susan Sealy Arquette |
First Address | North St. Paul, MN 55109-2496 |
Second Address | Woodbury, MN 55125-8204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 08/07/2007 |