Individual
DR. STANLEY CARL FERNEYHOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD, LP
Contact information
Practice address
220 N 6TH AVE E, DULUTH, MN 55805-1952
(218) 249-7000
Mailing address
20 LAKE ST N, SUITE 320, FOREST LAKE, MN 55025-2523
(651) 464-6900
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
—
—
103TR0400X
Rehabilitation Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
431250300
—
MN
Enumeration date
05/11/2006
Last updated
03/06/2009
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