Individual
PAMELA ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7600 143RD ST W, APPLE VALLEY, MN 55124-5528
(651) 373-9440
Mailing address
7600 143RD ST W STE 300, APPLE VALLEY, MN 55124-5529
(952) 201-6957
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
1431
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1518323442
NPI NUMBER
—
Enumeration date
01/07/2016
Last updated
03/20/2018
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