| Doctor Name: | AUDREY ELISSA BRANDT LOER |
| NPI Number: | 1053585083 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, LP |
| License Number: | LP 4917 |
| Business Practice Address: | 16 9th St Se Long Prairie, MN - 563471429 |
| Business Phone Number: | 3207326602 |
| Business Fax Number: | 3207326581 |
| Mailing Address: | 16 9th St Se, LONG PRAIRIE |
| State: | MN |
| Postal Code: | 563471429 |
| Phone Number: | 3207326602 |
| Fax Number: | 3207326581 |
| NPI Enumeration Date: | 04/22/2008 |
| NPI Last Update Date: | 04/22/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | LP 4917 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |