Healthcare Provider Details

I. General information

NPI: 1861513202
Provider Name (Legal Business Name): JUDY K AYERS M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 5TH AVE S SUITE 450
MINNEAPOLIS MN
55401-2540
US

IV. Provider business mailing address

155 5TH AVE S SUITE 450
MINNEAPOLIS MN
55401-2540
US

V. Phone/Fax

Practice location:
  • Phone: 612-333-2155
  • Fax: 612-333-5517
Mailing address:
  • Phone: 612-333-2155
  • Fax: 612-333-5517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberLP2316
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: