Healthcare Provider Details

I. General information

NPI: 1962597393
Provider Name (Legal Business Name): JOHN K MCALPINE PH.D., LP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15340 PAINTERS LN N
WEST LAKELAND MN
55082-1640
US

IV. Provider business mailing address

15340 PAINTERS LN N
WEST LAKELAND MN
55082-1640
US

V. Phone/Fax

Practice location:
  • Phone: 612-619-2577
  • Fax: 651-481-3907
Mailing address:
  • Phone: 612-619-2577
  • Fax: 651-481-3907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP1097
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: