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Individual

JUDITH ANN HAYNES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PH.D.

Contact information

Practice address
1407 24TH AVE S, GRAND FORKS, ND 58201-6761
(701) 746-6336
Mailing address
1407 24TH AVE S, GRAND FORKS, ND 58201-6761

Taxonomy

Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
176
ND

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
085222
VALUE OPTIONS
ND
05
12892
ND
01
24741
BLUECROSSBLUESHIELD OF ND
ND
01
638K4HA
BLUECROSSBLUESHIELD OF MN
MN
Enumeration date
10/04/2006
Last updated
07/08/2007
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