Individual
IVAN AYALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2450 RIVERSIDE AVE, UMMC F196, MINNEAPOLIS, MN 55454-1450
(952) 892-9536
Mailing address
2450 RIVERSIDE AVE, UMMC F196, MINNEAPOLIS, MN 55454-1450
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
23335
MN
106H00000X
Marriage & Family Therapist
Primary
2837
MN
Other
Enumeration date
12/17/2014
Last updated
04/07/2017
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