Individual
DR. THYRA ANNE FOSSUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1595 SELBY AVE, SUITE 109, SAINT PAUL, MN 55104-6221
(612) 229-8198
Mailing address
1595 SNELLING AVENUE, SUITE 109, SAINT PAUL, MN 55104
(612) 229-8198
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP4703
MN
Other
Enumeration date
11/04/2009
Last updated
06/30/2015
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