Agustin, Judith Louise Ross

Agustin, Judith Louise Ross is an sole proprietor health care provider with primary practice located at 8100 Penn Ave S Ste 150H , Bloomington MN 55431-1346. She recently has only one registered license in Behavioral Health & Social Service Providers / Marriage & Family Therapist, which is considered as her primary health care specialty. Agustin, Judith Louise Ross can be contacted via phone (612) 314-6012.

Contact Information

Primary practice address
8100 Penn Ave S Ste 150H Bloomington MN 55431-1346
Phone: (612) 314-6012
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X MT2659 Florida
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X 2534 Minnesota

Profile Details

NPI number 1003195082
LBN Legal business name Agustin, Judith Louise Ross
Credentials M.S., LMFT
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 9th, 2011
Last updated Jun 10th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003195082 NPPES
Other 1528451028 GROUP/BUSINESS ENTITY

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