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General NPI Number Information
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NPI Number | 1831264498
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Entity Type | Individual
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Provider Name | LOUISE AGNES GRIFFITH MA, LP
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Gender | Female
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 14575 GRAND AVE
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City | BURNSVILLE
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State | MN
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Zip | 55306-5722
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Country | US
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Telephone | 952-484-3100
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Fax | 952-898-4645
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Provider Business Mailing Address
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Address Line | 17637 KETTERING TRL
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City | LAKEVILLE
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State | MN
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Zip | 55044-9344
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Country | US
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Telephone | 952-484-3100
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Fax | 952-898-4645
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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 | LP1776
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License Number State | MN
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