Individual
REGINA M DRISCOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD LP
Contact information
Practice address
2332 LEXINGTON AVE N, ROSEVILLE, MN 55113-4336
(651) 247-3004
Mailing address
1492 ALBERT ST N, SAINT PAUL, MN 55108-2302
(651) 647-9760
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
LP1485
MN
103TC0700X
Clinical Psychologist
Primary
LP1485
MN
103TC2200X
Clinical Child & Adolescent Psychologist
LP1485
MN
103TH0100X
Health Service Psychologist
LP1485
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
910048200
—
MN
Enumeration date
08/17/2006
Last updated
12/11/2008
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