Doctor Name: | TRESSA KAY REISETTER |
NPI Number: | 1467597567 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD |
License Number: | LP4752 |
Business Practice Address: | 11652 Nevada Ln Champlin, MN - 553162885 |
Business Phone Number: | 6125972737 |
Business Fax Number: | 7635662944 |
Mailing Address: | 11652 Nevada Ln, CHAMPLIN |
State: | MN |
Postal Code: | 553162885 |
Phone Number: | 6125972737 |
Fax Number: | 7635662944 |
NPI Enumeration Date: | 02/20/2007 |
NPI Last Update Date: | 01/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | LP4752 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |