Individual
MR. STEVEN PETER DAFFINRUD
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MA LP
Contact information
Practice address
600 25TH AVE S, ROOSEVELT OFFICE PARK SUITE 109, SAINT CLOUD, MN 56301-4841
(320) 255-0343
(320) 654-0318
Mailing address
600 25TH AVE S, ROOSEVELT OFFICE PARK SUITE 109, SAINT CLOUD, MN 56301-4841
(320) 255-0343
(320) 654-0318
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP3707
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116812
U CARE
MN
01
—
3041301
BHP
MN
01
—
314K4DA
BCBS BLUE PLUS COMPCARE
MN
01
—
625T442
UBH
—
05
—
7144245
—
MN
01
—
S01906459
MMSI
—
Enumeration date
11/18/2005
Last updated
07/08/2007
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