Individual
THARAKI SIYAGUNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1547 30TH AVE S, MOORHEAD, MN 56560-5055
(218) 287-4338
(218) 287-5928
Mailing address
1547 30TH AVE S, MOORHEAD, MN 56560-5055
(218) 287-4338
(218) 287-5928
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP6711
MN
174400000X
Specialist
—
—
Other
Enumeration date
09/12/2018
Last updated
10/16/2025
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