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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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