Provider Demographics
NPI:1558783050
Name:TANAKA, AKIKO (PHD, LP,)
Entity Type:Individual
Prefix:
First Name:AKIKO
Middle Name:
Last Name:TANAKA
Suffix:
Gender:F
Credentials:PHD, LP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 GRAND AVE
Mailing Address - Street 2:SUITE 213
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2582
Mailing Address - Country:US
Mailing Address - Phone:612-547-9170
Mailing Address - Fax:
Practice Address - Street 1:333 GRAND AVE
Practice Address - Street 2:SUITE 213
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2582
Practice Address - Country:US
Practice Address - Phone:612-547-9170
Practice Address - Fax:651-433-7390
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-17
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5699103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist