Most Relevant Information
Provider Data
| NPI Number: | 1003656760 |
| Provider Name: | KURT ROBERT ILLIG PHD, LP |
| Entity Type: | Individual |
| Taxonomy Code: | 103TC0700X |
| Specialty: | Psychologist |
| License Number: | LP7058 |
Most Important Dates
| Enumeration Date: | 05/30/2024 |
| Last Updated: | 06/06/2024 |
Provider Practice Location
3795 PILOT KNOB RD
EAGAN
MN
551223176
Practice Location Phone/Fax
| Phone: | 9525955652 |
| Fax: |
Provider Mailing Location
3795 PILOT KNOB RD
EAGAN
MN
551223176
Provider Mailing Phone/Fax
| Phone: | 9525955652 |
| Fax: |