Organization
CLOQUET PSYCHOLOGICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CAROLINE LOUISE NELSON PSYDLP (LICENSED PSYCHOLOGIST)
(218) 940-5259
Entity
Organization
Contact information
Practice address
605 KALLSTROM RD, CLOQUET, MN 55720-9415
(218) 940-5259
Mailing address
605 KALLSTROM RD, CLOQUET, MN 55720-9415
(218) 940-5259
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP4209
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
417629400
—
MN
01
—
680001706
MEDICARE PTAN
MN
Enumeration date
03/12/2013
Last updated
03/12/2013
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