Healthcare Provider Details

I. General information

NPI: 1053383679
Provider Name (Legal Business Name): KAROL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 SINGLETREE LN #203
EDEN PRAIRIE MN
55344-5328
US

IV. Provider business mailing address

9637 ANDERSON LAKES PKWY SUITE 162
EDEN PRAIRIE MN
55344-4155
US

V. Phone/Fax

Practice location:
  • Phone: 952-944-5502
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT L. KAROL
Title or Position: OWNER
Credential: PH.D., L.P.
Phone: 952-944-5502