Healthcare Provider Details

I. General information

NPI: 1144269028
Provider Name (Legal Business Name): JANE STEWART ROZNOVSKY PHD LP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5706 HYLAND COURTS DR
BLOOMINGTON MN
55437-1933
US

IV. Provider business mailing address

PO BOX 65
MUSE OK
74949-0065
US

V. Phone/Fax

Practice location:
  • Phone: 952-893-1155
  • Fax:
Mailing address:
  • Phone: 918-651-3570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP0308
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: