Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | LP0906 | MN |
NPI | 1013122837 |
---|---|
Provider Name | Therese Jacobs-Stewart |
First Address | Saint Paul, MN 55105-1650 |
Second Address | Saint Paul, MN 55105-1650 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 30/11/2011 |