Healthcare Provider Details

I. General information

NPI: 1851372809
Provider Name (Legal Business Name): STACY HUGHES ANDERSON MSE LP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 MAIN ST
WINONA MN
55987-3405
US

IV. Provider business mailing address

166 MAIN ST
WINONA MN
55987-3405
US

V. Phone/Fax

Practice location:
  • Phone: 507-454-4341
  • Fax: 507-453-6267
Mailing address:
  • Phone: 507-454-4341
  • Fax: 507-453-6267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP3610
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: