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General NPI Number Information
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NPI Number | 1225628217
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Entity Type | Individual
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Provider Name | MS. ASHLEY NICOLE CERMAK
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Gender | Female
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Dates
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Enumeration Date | 01/22/2021
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Last Update Date | 01/22/2021
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Provider Practice Location Address
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Address Line | 145 HAMEL RD
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City | MEDINA
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State | MN
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Zip | 55340-9535
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Country | US
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Telephone | 612-756-9107
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Fax |
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Provider Business Mailing Address
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Address Line | 6552 CARRIAGE WAY
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City | CORCORAN
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State | MN
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Zip | 55340-4443
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Country | US
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Telephone | 612-756-9107
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Fax | 621-235-3398
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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