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6980 Fairview Rd Suite 110 Baxter MN 56425-7836 | |
(218) 822-3736 | |
(218) 822-3761 |
Full Name | |
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Speciality | Psychologist |
Location | 6980 Fairview Rd, Baxter, Minnesota |
Authorized Official Name and Position | Jerry E. Jensen (DIRECTOR) |
Authorized Official Contact | 2188223736 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 2633 Baxter MN 56425-2633 Ph: (218) 822-3736 | 6980 Fairview Rd Suite 110 Baxter MN 56425-7836 Ph: (218) 822-3736 |
NPI Number | 1871596585 |
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Provider Enumeration Date | 05/27/2005 |
Last Update Date | 02/10/2009 |
Identifier | Type | State | Issuer |
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1871596585 | NPI | - | NPPES |
555519100 | Medicaid | MN |
Taxonomy | Type | License (State) | Status |
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103T00000X | Psychologist | LP 4642 (Minnesota) | Primary |
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