Healthcare Provider Details

I. General information

NPI: 1316337504
Provider Name (Legal Business Name): PETRA WOEHRLE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N 6TH AVE E
DULUTH MN
55805-1952
US

IV. Provider business mailing address

220 N 6TH AVE E
DULUTH MN
55805-1952
US

V. Phone/Fax

Practice location:
  • Phone: 218-249-7000
  • Fax: 218-249-7050
Mailing address:
  • Phone: 218-249-7000
  • Fax: 218-249-7050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLP5854
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: