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19765 Highway 7 Suite 203 Shorewood MN 55331 | |
(952) 767-0442 | |
(952) 854-1647 |
Full Name | |
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Speciality | Marriage & Family Therapist |
Location | 19765 Highway 7, Shorewood, Minnesota |
Authorized Official Name and Position | Roger A. Ballou (CO-OWNER) |
Authorized Official Contact | 9527670442 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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19765 Highway 7 Suite 203 Shorewood MN 55331 Ph: (952) 767-0442 | 19765 Highway 7 Suite 203 Shorewood MN 55331 Ph: (952) 767-0442 |
NPI Number | 1417204751 |
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Provider Enumeration Date | 08/06/2012 |
Last Update Date | 07/10/2014 |
Identifier | Type | State | Issuer |
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1417204751 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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106H00000X | Marriage & Family Therapist | 1130 (Minnesota) | Primary |