Individual
DR. STEPHANIE ELIZABETH TACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD, LP
Contact information
Practice address
280 SMITH AVE N STE 450, SAINT PAUL, MN 55102-2481
(651) 241-5959
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-9000
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP6859
MN
Other
Enumeration date
10/17/2022
Last updated
07/30/2024
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