Healthcare Provider Details

I. General information

NPI: 1699704932
Provider Name (Legal Business Name): EDWIN EUGENE NIEMI PSYCHOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 1ST AVE
TWO HARBORS MN
55616-1505
US

IV. Provider business mailing address

1401 EAST FIRST STREET
DULUTH MN
55805
US

V. Phone/Fax

Practice location:
  • Phone: 218-834-5520
  • Fax: 218-834-4264
Mailing address:
  • Phone: 218-728-4491
  • Fax: 218-728-4404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP2144
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: