Individual
AYODELE REGINA DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MENTAL HEALTH PRACTI
Contact information
Practice address
2800 FREEWAY BLVD STE 204, MINNEAPOLIS, MN 55430-1751
(763) 412-1996
(763) 292-5653
Mailing address
2800 FREEWAY BLVD STE 204, MINNEAPOLIS, MN 55430-1751
(763) 412-1996
(763) 292-5653
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
874647200
—
MN
Enumeration date
01/21/2020
Last updated
01/21/2020
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