Doctor Name: | MICHELLE K. PEMBLE |
NPI Number: | 1013116342 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD |
License Number: | LP4824 |
Business Practice Address: | 101 Martin Luther King Dr Mankato, MN - 560016460 |
Business Phone Number: | 5073856500 |
Business Fax Number: | |
Mailing Address: | 1025 Marsh St, MANKATO |
State: | MN |
Postal Code: | 560014752 |
Phone Number: | 5076254031 |
Fax Number: | |
NPI Enumeration Date: | 07/17/2007 |
NPI Last Update Date: | 07/17/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TB0200X |
License Number: | LP4824 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Cognitive & Behavioral |
Taxonomy Definition: |