Healthcare Provider Details

I. General information

NPI: 1477990570
Provider Name (Legal Business Name): AIMEE JO SITZER ARIKIAN PH.D., LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 COMO AVE
SAINT PAUL MN
55108-1737
US

IV. Provider business mailing address

2265 COMO AVE
SAINT PAUL MN
55108-1737
US

V. Phone/Fax

Practice location:
  • Phone: 651-645-5323
  • Fax: 651-641-6190
Mailing address:
  • Phone: 651-645-5323
  • Fax: 651-641-6190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP 5611
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberLP 5611
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberLP 5611
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License NumberLP 5611
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberLP 5611
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: