Individual
MARILYNN KAY BAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD LP
Contact information
Practice address
3033 EXCELSIOR BLVD, SUITE 10, MINNEAPOLIS, MN 55416
(612) 920-6161
(612) 827-4341
Mailing address
4132 HARRIET AVENUE SOUTH, MINNEAPOLIS, MN 55409
(612) 920-6161
(612) 827-4341
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
LP2207
MN
163W00000X
Registered Nurse
Primary
R0653855
MN
Other
Enumeration date
05/17/2007
Last updated
09/11/2025
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