Individual
IRIS SONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D., L.P.
Contact information
Practice address
7979 RANCHVIEW LN N, MAPLE GROVE, MN 55311-2106
(612) 203-8027
Mailing address
7979 RANCHVIEW LN N, MAPLE GROVE, MN 55311-2106
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP5547
MN
Other
Enumeration date
10/23/2014
Last updated
10/23/2014
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