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General NPI Number Information
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NPI Number | 1609015890
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Entity Type | Individual
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Provider Name | MYRON JOSEPH VEENSTRA PH.D
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Gender | Male
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 02/11/2009
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Provider Practice Location Address
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Address Line | 20531 US HIGHWAY 75 SW
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City | CROOKSTON
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State | MN
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Zip | 56716-9045
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Country | US
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Telephone | 218-281-3351
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Fax | 218-281-1947
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Provider Business Mailing Address
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Address Line | 20531 US HIGHWAY 75 SW
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City | CROOKSTON
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State | MN
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Zip | 56716-9045
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Country | US
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Telephone | 218-281-3351
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Fax | 218-281-1947
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State | ND
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