-- MARK R FASTNER -- MA LP
Individual Provider (NPI-1)
Active
Psychologist, Clinical
Provider Information
- NPI Number
1942278577- Provider Type
- Individual Provider (NPI-1)
- Credentials
- MA LP
- Status
- Active
Contact & Location
- Address
- 1811 WEIR DRIVE SUITE 355 MAIL STOP 13701A, WOODBURY, MN, 551252273
- Phone
- (651) 730-6151
- Fax
- (651) 730-1700
Specialties & Taxonomies
Psychologist, Clinical
Primary License: MN #2844