Individual
MRS. JEAN MICHELLE BANNICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOTR/L
Contact information
Practice address
7900 W 28TH ST, ST LOUIS PARK, MN 55426-3011
(651) 698-0830
Mailing address
7900 W 28TH ST, ST LOUIS PARK, MN 55426-3011
(651) 698-0830
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
103792
MN
Other
Enumeration date
12/19/2009
Last updated
12/19/2009
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