Doctor Name: | MS. GLENDA RUTH CEDARLEAF |
NPI Number: | 1023219516 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LICSW |
License Number: | 17268 |
Business Practice Address: | 10201 Wayzata Blvd Suite 350 Minnetonka, MN - 553055507 |
Business Phone Number: | 7635465797 |
Business Fax Number: | 7635465754 |
Mailing Address: | 10201 Wayzata Blvd, Suite 350 MINNETONKA |
State: | MN |
Postal Code: | 553055507 |
Phone Number: | 7635465797 |
Fax Number: | 7635465754 |
NPI Enumeration Date: | 05/30/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 17268 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |