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NPI 1063519262

NPI 1063519262 : CENTER FOR PERSONAL & PROFESSIONAL GROWTH, LLC : ROCHESTER, MN

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General NPI Number Information
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    NPI Number           |    1063519262
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    Entity Type          |    Organization 
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    Legal Business Name  |    CENTER FOR PERSONAL & PROFESSIONAL GROWTH, LLC 
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Dates
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    Enumeration Date     |    09/20/2006
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    Last Update Date     |    06/16/2008
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Provider Practice Location Address
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    Address Line         |    400 S BROADWAY STE 16
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    City                 |    ROCHESTER
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    State                |    MN
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    Zip                  |    55904
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    Country              |    US
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    Telephone            |    507-252-5700
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    Fax                  |    507-252-8115
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Provider Business Mailing Address
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    Address Line         |    400 S BROADWAY STE 16
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    City                 |    ROCHESTER
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    State                |    MN
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    Zip                  |    55904
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    Country              |    US
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    Telephone            |    507-252-5700
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    Fax                  |    507-252-8115
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Authorized Official
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    Title or Position    |    OWNER
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    Name                 |     VICTORIA  VOLSTAD 
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    Credential           |    MS LP
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    Telephone            |    507-252-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    103T00000X
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    Taxonomy Name        |    Psychologist
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    License Number       |    LP3327
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    License Number State |    MN
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