Provider Demographics
NPI:1376656991
Name:ALDEN, JEREMY T (PHD LP)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:T
Last Name:ALDEN
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Gender:M
Credentials:PHD LP
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Mailing Address - Street 1:2910 CENTRE POINTE DRIVE
Mailing Address - Street 2:35 121A CHILDRENS HEALTH CARE
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:651-855-2327
Mailing Address - Fax:651-855-2310
Practice Address - Street 1:347 NORTH SMITH AVENUE
Practice Address - Street 2:CHILDRENS SPECIALTY CLINIC PSYCHOLOGICAL SERVICES
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-220-6720
Practice Address - Fax:651-220-6707
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MNLP4240103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist