Port of Crow Wing County, INC

NPI #1205904612 in Little Falls, Minnesota

Provider Information

NPI Number: 1205904612
Entity Type: Organization
Organization Name: Port of Crow Wing County, INC
Primary Specialty: Psychologist - Cognitive & Behavioral
Enumeration Date: Dec 1, 2006
Last Updated: May 20, 2022

Practice Location

Address: 1906 5TH AVE SE
City: Little Falls
State: Minnesota
ZIP Code: 56345-3317
Phone: (320) 632-6647

Authorized Official

Name: MS. AMY HAIDER
Title: CREDENTIALING MANAGER
Phone: (320) 639-1425

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist - Cognitive & Behavioral — Cognitive & Behavioral	103TB0200X	Primary

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