Organization
DEREK PROWE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEREK EVAN PROWE PSYD (OWNER)
(612) 656-9122
Entity
Organization
Contact information
Practice address
4749 CHICAGO AVE, SUITE 1D, MINNEAPOLIS, MN 55407-3556
(612) 656-9122
Mailing address
4749 CHICAGO AVE, SUITE 1D, MINNEAPOLIS, MN 55407-3556
(612) 656-9122
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP5238
MN
Other
Enumeration date
02/29/2016
Last updated
02/29/2016
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