Individual
DR. MICAH PRAIRIE CHICKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD, LP
Contact information
Practice address
2101 MINNEHAHA AVE, MINNEAPOLIS, MN 55404-3107
(612) 721-9877
Mailing address
2101 MINNEHAHA AVE, MINNEAPOLIS, MN 55404-3107
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP6960
MN
Other
Enumeration date
08/08/2023
Last updated
08/08/2023
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