Individual
ASLI BAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
16315 WAGNER WAY APT 210E, EDEN PRAIRIE, MN 55344-5735
(312) 684-8620
Mailing address
16315 WAGNER WAY APT 210E, EDEN PRAIRIE, MN 55344-5735
(312) 684-8620
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
10/07/2021
Last updated
10/07/2021
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