Individual
CHARLES GERALD DEPIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD LP
Contact information
Practice address
2220 RIVERSIDE AVE S, MAIL STOP 31700A, MINNEAPOLIS, MN 55454-1321
(612) 371-1600
(612) 371-1732
Mailing address
8100 34TH AVE S, 21110Q, BLOOMINGTON, MN 55425-1672
(952) 883-7961
(952) 883-5395
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2960
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
190217200
—
MN
Enumeration date
02/17/2006
Last updated
03/11/2021
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