Individual
DR. VERNON T DEVINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
4500 PARK GLEN RD, SUITE 360, ST LOUIS PARK, MN 55416-4871
(952) 929-9478
(952) 929-9548
Mailing address
4500 PARK GLEN RD, SUITE 360, ST LOUIS PARK, MN 55416-4871
(952) 929-9478
(952) 929-9548
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP0131
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181547400
—
MN
01
—
1F223DE
BCBSMN
MN
01
—
61-20116
UBH
MN
Enumeration date
09/28/2006
Last updated
07/08/2007
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