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NPI Code Detail

MEDICARE: MRS. BRENDA JANICE CRESPO PSYD

MEDICARE: MRS. BRENDA JANICE CRESPO PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist6465MN

General Provider Information

NPI Number : 1720117997
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BRENDA JANICE CRESPO PSYD
Provider Business Mailing Address
First Line : 9120 SPRINGBROOK DR NW
Second Line :
City : COON RAPIDS
State : MN
Zip : 55433-5845
Country : US
Telephone Number : 763-233-7272
Fax Number :
Provider Business Practice Location Address
First Line : 9120 SPRINGBROOK DR NW
Second Line :
City : COON RAPIDS
State : MN
Zip : 55433-5845
Country : US
Telephone Number : 763-233-7272
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 06/28/2022

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