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General NPI Number Information
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NPI Number | 1437934890
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Entity Type | Individual
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Provider Name | AYALA GORODZINSKY LP, PHD
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Gender | Female
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Dates
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Enumeration Date | 08/25/2023
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Last Update Date | 08/25/2023
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Provider Practice Location Address
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Address Line | 2525 CHICAGO AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55404-4518
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Country | US
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Telephone | 612-813-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 1658 BEDFORD HIGHWAY 2015
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City | BEDFORD
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State | NOVA SCOTIA
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Zip | B4A2X9
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Country | CA
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Telephone |
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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 | LP6959
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License Number State | MN
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