| Lake Superior Psychological Services, Inc. | |
|
4891 Miller Trunk Hwy Suite 106 Hermantown MN 55811-1512 | |
| (218) 722-2525 | |
| (218) 722-1033 |
| Full Name | Lake Superior Psychological Services, Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4891 Miller Trunk Hwy, Hermantown, Minnesota |
| Authorized Official Name and Position | Jeffrey Lynn Olson (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 2187222525 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Superior Psychological Services, Inc. 4891 Miller Trunk Hwy Suite 106 Hermantown MN 55811-1512 Ph: (218) 722-2525 | Lake Superior Psychological Services, Inc. 4891 Miller Trunk Hwy Suite 106 Hermantown MN 55811-1512 Ph: (218) 722-2525 |
| NPI Number | 1396089660 |
|---|---|
| Provider Enumeration Date | 11/26/2012 |
| Last Update Date | 02/06/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396089660 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LP4532 (Minnesota) | Primary |
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