Healthcare Provider Details

I. General information

NPI: 1649350596
Provider Name (Legal Business Name): EILEEN BRIGID SEXTON PH.D., LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 NORTH MAIN ST SUITE 203
STILLWATER MN
55082
US

IV. Provider business mailing address

10810 QUARRY AVE N
STILLWATER MN
55082
US

V. Phone/Fax

Practice location:
  • Phone: 651-271-4163
  • Fax: 651-439-2284
Mailing address:
  • Phone: 651-271-4163
  • Fax: 651-439-2284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP 3299
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: