Individual
SALLY D MAXWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LP
Contact information
Practice address
502 EAST 2ND STREET, DULUTH, MN 55805
(218) 727-8762
Mailing address
502 EAST 2ND STREET, DULUTH, MN 55805
(218) 727-8762
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3150
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3150
PSYCHOLOGY LICENSE
MN
Enumeration date
10/03/2006
Last updated
09/30/2008
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