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General NPI Number Information
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NPI Number | 1255861324
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Entity Type | Organization
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Legal Business Name | BALCOME AND DICKE PSYCHOLOGY PROFESSIONALS
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Dates
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Enumeration Date | 06/12/2017
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Last Update Date | 06/12/2017
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Provider Practice Location Address
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Address Line | 1104 OAK ST
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City | RED WING
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State | MN
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Zip | 55066-2430
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Country | US
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Telephone | 661-803-6702
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Fax | 661-803-6702
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Provider Business Mailing Address
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Address Line | 1104 OAK ST
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City | RED WING
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State | MN
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Zip | 55066-2430
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Country | US
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Telephone | 661-803-6702
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Fax |
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Authorized Official
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Title or Position | PARNTER
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Name | JOAN BALCOME616
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Credential |
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Telephone | 661-803-6702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8738
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License Number State | MN
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