Individual
JEANNE MARIE KURTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, LP
Contact information
Practice address
7115 FORTHUN ROAD, SUITE 105, BAXTER, MN 56425
(218) 454-0090
(218) 454-0091
Mailing address
7115 FORTHUN ROAD, SUITE 105, BAXTER, MN 56425
(218) 454-0090
(218) 454-0091
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP2689
MN
103TC0700X
Clinical Psychologist
LP2689
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4209552
—
MN
01
—
LP2689
LICENSED PSYCHOLOGIST
MN
Enumeration date
12/15/2006
Last updated
05/26/2011
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