Individual
MARTHA E DILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. L.P.
Contact information
Practice address
525 PORTLAND AVE, MINNEAPOLIS, MN 55415-1533
(612) 964-1778
Mailing address
16982 DEWITTE AVE SW, PRIOR LAKE, MN 55372-2310
(952) 237-6168
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3470
MN
Other
Enumeration date
11/28/2012
Last updated
11/28/2012
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