Individual
JACQULINE LIBBY DEXTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSLP
Contact information
Practice address
3137 HENNEPIN AVE STE 202, MINNEAPOLIS, MN 55408-2602
(612) 827-0777
(612) 827-0777
Mailing address
3137 HENNEPIN AVE STE 202, MINNEAPOLIS, MN 55408-2602
(612) 827-0777
(612) 827-0777
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP2837
MN
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
R083276
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8H854DE
BLUE CROSS BLUE SHEILD
MN
Enumeration date
07/27/2006
Last updated
09/25/2007
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