Most Relevant Information
Provider Data
| NPI Number: | 1003195082 |
| Provider Name: | JUDITH LOUISE ROSS AGUSTIN M.S., LMFT |
| Entity Type: | Individual |
| Taxonomy Code: | 106H00000X |
| Specialty: | Marriage & Family Therapist |
| License Number: | MT2659 |
Most Important Dates
| Enumeration Date: | 08/09/2011 |
| Last Updated: | 06/10/2019 |
Provider Practice Location
8100 PENN AVE S STE 150H
BLOOMINGTON
MN
554311346
Practice Location Phone/Fax
| Phone: | 6123146012 |
| Fax: |
Provider Mailing Location
8100 PENN AVE S STE 150H
BLOOMINGTON
MN
554311346
Provider Mailing Phone/Fax
| Phone: | 6123146012 |
| Fax: |