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Individual

DR. COLLIN ROSS MODAHL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LP

Contact information

Practice address
324 BROADWAY ST STE 206, ALEXANDRIA, MN 56308-1482
(320) 762-1762
(320) 762-1762
Mailing address
324 BROADWAY ST STE 206, ALEXANDRIA, MN 56308-1482
(320) 762-1762
(320) 762-0796

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP6478
MN

Other

Enumeration date
11/18/2019
Last updated
11/18/2019
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