=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437163417
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRYN YAHN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14275 GOLF COURSE DR. SUITE 160
-----------------------------------------------------
City | BAXTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-828-1028
-----------------------------------------------------
Fax | 218-824-0137
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27110 W TWIN LAKE DR
-----------------------------------------------------
City | PEQUOT LAKES
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56472-2851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------