Healthcare Provider Details

I. General information

NPI: 1790795797
Provider Name (Legal Business Name): BRYAN JON STENLUND M.S./L.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 S POKEGAMA AVE STE B
GRAND RAPIDS MN
55744
US

IV. Provider business mailing address

516 S POKEGAMA AVE STE B
GRAND RAPIDS MN
55744
US

V. Phone/Fax

Practice location:
  • Phone: 218-327-8937
  • Fax: 218-327-0348
Mailing address:
  • Phone: 218-327-8937
  • Fax: 218-327-0348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP2760
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: