Individual
DUSTY RENEE HACKLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
9555 UPLAND LN N, MAPLE GROVE, MN 55369-4485
(952) 993-3307
Mailing address
9555 UPLAND LN N, MAILSTOP:62M03B, MAPLE GROVE, MN 55369-4485
(952) 993-3307
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
LP6194
MN
Other
Enumeration date
11/29/2017
Last updated
11/29/2017
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