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General NPI Number Information
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NPI Number | 1275819914
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Entity Type | Organization
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Legal Business Name | DYNAMIC PATH PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 10/26/2011
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Last Update Date | 11/02/2025
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Provider Practice Location Address
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Address Line | 5874 BLACKSHIRE PATH
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City | INVER GROVE HEIGHTS
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State | MN
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Zip | 55076-1621
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Country | US
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Telephone | 651-317-3656
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Fax | 888-965-5676
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Provider Business Mailing Address
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Address Line | 5874 BLACKSHIRE PATH
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City | INVER GROVE HEIGHTS
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State | MN
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Zip | 55076-1621
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Country | US
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Telephone | 651-317-3656
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Fax | 888-965-5676
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Authorized Official
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Title or Position | OWNER, SOLE OPERATOR
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Name | DR. KATRINA SAMLASKA
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Credential |
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Telephone | 651-317-3656
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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 | 5411
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License Number State | MN
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