| Illuminate | |
|
8615 Eagle Point Blvd Lake Elmo MN 55042-8628 | |
| (651) 264-0444 | |
| (651) 264-0447 |
| Full Name | Illuminate |
|---|---|
| Speciality | Psychologist |
| Location | 8615 Eagle Point Blvd, Lake Elmo, Minnesota |
| Authorized Official Name and Position | Sharon Blossom (PRESIDENT) |
| Authorized Official Contact | 6512640444 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Illuminate 8615 Eagle Point Blvd Lake Elmo MN 55042-8628 Ph: (651) 264-0444 | Illuminate 8615 Eagle Point Blvd Lake Elmo MN 55042-8628 Ph: (651) 264-0444 |
| NPI Number | 1336301894 |
|---|---|
| Provider Enumeration Date | 06/26/2008 |
| Last Update Date | 06/26/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336301894 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | LP-1196 (Minnesota) | Primary |
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