Individual
DR. MALLORY OBERMIRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D., LP
Contact information
Practice address
1516 W LAKE ST, MINNEAPOLIS, MN 55408-2554
(612) 823-3707
Mailing address
2712 FREMONT AVE S, MINNEAPOLIS, MN 55408-1122
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP6002
MN
Other
Enumeration date
09/28/2016
Last updated
09/28/2016
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