Individual
MARY BETH SCANLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, LP
Contact information
Practice address
1110 YANKEE DOODLE RD, EAGAN, MN 55121-2092
(651) 454-3970
(651) 241-0059
Mailing address
PO BOX 43, MR 10809, MINNEAPOLIS, MN 55440-0043
(612) 262-4813
(612) 262-4194
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP1288
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
373053100
—
MN
Enumeration date
04/10/2006
Last updated
03/11/2021
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