Individual
JUDITH LOUISE ROSS AGUSTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., LMFT
Contact information
Practice address
8100 PENN AVE S STE 150H, BLOOMINGTON, MN 55431-1346
(612) 314-6012
Mailing address
8100 PENN AVE S STE 150H, BLOOMINGTON, MN 55431-1346
(612) 314-6012
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
2534
MN
106H00000X
Marriage & Family Therapist
MT2659
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1528451028
GROUP/BUSINESS ENTITY
—
Enumeration date
08/09/2011
Last updated
06/10/2019
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