Provider Demographics
NPI:1770655706
Name:PARLOW, SIMMIE J (PHD)
Entity Type:Individual
Prefix:DR
First Name:SIMMIE
Middle Name:J
Last Name:PARLOW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:366 PRIOR AVE N
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-5165
Mailing Address - Country:US
Mailing Address - Phone:651-482-8467
Mailing Address - Fax:651-330-4200
Practice Address - Street 1:366 PRIOR AVE N
Practice Address - Street 2:SUITE 202
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-5165
Practice Address - Country:US
Practice Address - Phone:651-482-8467
Practice Address - Fax:651-330-4200
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP2888103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN61-08958OtherMEDICA
MN830053400Medicaid
MN2H186PAOtherBLUE CROSS