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Contact Information

BRENDA L DESTACHE, MSLP
1976 WOODALE DR
WOODBURY, MN55125
 Phone: 651-730-8464
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychologist

103T00000X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for BRENDA L DESTACHE · (Female)

NPI # 1518132737
Status Active
Credentials MSLP
Entity Individual
Enumeration date 04/29/2008
Last updated 04/29/2008 - About 18 years ago
Sole proprietor 1 Yes
Identifiers
  • MN License # LP2836
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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