Individual
CAROL ELAINE MECKLENBURG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD LP
Contact information
Practice address
2399 ARIEL ST N STE D, MAPLEWOOD, MN 55109-2202
(651) 770-1311
(651) 770-1879
Mailing address
707 HAMLINE AVE S, SAINT PAUL, MN 55116-2238
(651) 431-0305
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
4962
MN
103TS0200X
School Psychologist
254940
MN
Other
Enumeration date
10/14/2008
Last updated
10/14/2008
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