Healthcare Provider Details

I. General information

NPI: 1194913798
Provider Name (Legal Business Name): LINDA R HAMANN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 CENTER AVE STE 410
MOORHEAD MN
56560-1975
US

IV. Provider business mailing address

403 CENTER AVE STE 410
MOORHEAD MN
56560-1975
US

V. Phone/Fax

Practice location:
  • Phone: 218-227-0338
  • Fax:
Mailing address:
  • Phone: 218-227-0338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP 3183
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LINDA R HAMANN
Title or Position: LICENSED PSYCHOLOGIST
Credential: MS LP
Phone: 218-227-0338