Provider Demographics
NPI:1992825053
Name:STERNAL, MARLYN JEAN (LP 0663)
Entity Type:Individual
Prefix:
First Name:MARLYN
Middle Name:JEAN
Last Name:STERNAL
Suffix:
Gender:F
Credentials:LP 0663
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 N 2ND AVE E
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2102
Mailing Address - Country:US
Mailing Address - Phone:218-391-6612
Mailing Address - Fax:
Practice Address - Street 1:8 N 2ND AVE E
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2102
Practice Address - Country:US
Practice Address - Phone:218-391-6612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 0663103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist