Individual
MARA D PEASE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD, LP
Contact information
Practice address
1600 UNIVERSITY AVE W, SUITE 12, ST PAUL, MN 55104
(651) 379-5157
(651) 379-5159
Mailing address
1600 UNIVERSITY AVE W, SUITE 12, ST PAUL, MN 55104-3898
(651) 379-5157
(651) 379-5159
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP6204
MN
103T00000X
Psychologist
—
MN
Other
Enumeration date
06/21/2016
Last updated
07/30/2018
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