Individual
DR. THERESA J BERNARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD, LP
Contact information
Practice address
4432 CHICAGO AVE, MINNEAPOLIS, MN 55407-3519
(612) 870-2453
Mailing address
3705 15TH AVE S, MINNEAPOLIS, MN 55407-2717
(612) 729-7190
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP4565
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
221066500
—
MN
Enumeration date
11/22/2006
Last updated
04/02/2009
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