Individual
TRESSA KAY REISETTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, LP, NCSP
Contact information
Practice address
621 RED OAK DR, BIG LAKE, MN 55309-9585
(612) 597-2737
Mailing address
621 RED OAK DR, BIG LAKE, MN 55309-9585
(612) 597-2737
(763) 566-2944
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
LP4752
MN
103TC0700X
Clinical Psychologist
2019014342
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14450911
CAQH
—
Enumeration date
02/20/2007
Last updated
04/17/2020
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