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General NPI Number Information
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NPI Number | 1225401433
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Entity Type | Organization
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Legal Business Name | DENISE TROMBLAY, MA, LP
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Dates
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Enumeration Date | 11/10/2015
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Last Update Date | 11/10/2015
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Provider Practice Location Address
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Address Line | 615 W 35TH ST
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-4602
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Country | US
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Telephone | 612-418-5812
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Fax |
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Provider Business Mailing Address
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Address Line | 615 W 35TH ST
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-4602
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Country | US
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Telephone | 612-418-5812
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CJ HORDYNSKI
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Credential |
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Telephone | 612-237-9238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3966
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License Number State | MN
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