Individual
CRAIG CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LP
Contact information
Practice address
13100 WAYZATA BLVD STE 200, MINNETONKA, MN 55305-1810
(952) 206-2040
(952) 206-2041
Mailing address
1900 SILVER LAKE RD NW, NEW BRIGHTON, MN 55112-1786
(651) 628-9566
(651) 628-0411
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP3482
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
409216300
—
MN
Enumeration date
05/23/2007
Last updated
05/07/2019
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