Individual
VICKIE LYNN POTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., L.P.
Contact information
Practice address
290 9TH AVE, GRANITE FALLS, MN 56241-1439
(320) 564-5670
Mailing address
97 PLEASANT ST, GRANITE FALLS, MN 56241-9470
(320) 564-2488
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2895
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
114832
U CARE
MN
01
—
2897227
TAX NUMBER
MN
01
—
9H516PO
BLUE CROSS BLUE SHIELD
MN
01
—
L.P 2895
L.P. NUMBER
MN
01
—
P51552
ARAZ CODE
MN
Enumeration date
10/15/2006
Last updated
07/08/2007
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