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General NPI Number Information
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NPI Number | 1871555441
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Entity Type | Organization
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Legal Business Name | ST. CLOUD NEUROBEHAVIORAL ASSOCIATES PA
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 3812 8TH ST N STE 200
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City | SAINT CLOUD
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State | MN
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Zip | 56303-1413
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Country | US
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Telephone | 320-258-3833
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Fax | 320-253-5741
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Provider Business Mailing Address
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Address Line | 3812 8TH ST N STE 200
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City | SAINT CLOUD
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State | MN
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Zip | 56303-1413
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Country | US
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Telephone | 320-258-3833
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Fax | 320-253-5741
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JESSICA WARD
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Credential |
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Telephone | 320-258-3833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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