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General NPI Number Information
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NPI Number | 1235713876
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Entity Type | Individual
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Provider Name | ADRIENNE VANZOMEREN PH.D., L.P.
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Gender | Female
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Dates
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Enumeration Date | 05/10/2021
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Last Update Date | 05/10/2021
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Provider Practice Location Address
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Address Line | 202 N CEDAR AVE STE 1
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City | OWATONNA
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State | MN
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Zip | 55060
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Country | US
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Telephone | 651-796-1480
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Fax |
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Provider Business Mailing Address
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Address Line | 1041 GRAND AVE STE 387
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City | SAINT PAUL
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State | MN
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Zip | 55105-3002
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Country | US
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Telephone | 651-796-1480
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6564
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License Number State | MN
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