Healthcare Provider Details

I. General information

NPI: 1689727984
Provider Name (Legal Business Name): MARY ELIZABETH DOLEJSI LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 JAMES AVE S SUITE 103
MINNEAPOLIS MN
55408-2533
US

IV. Provider business mailing address

3005 JAMES AVE S SUITE 103
MINNEAPOLIS MN
55408-2533
US

V. Phone/Fax

Practice location:
  • Phone: 612-377-7500
  • Fax: 612-377-7501
Mailing address:
  • Phone: 612-377-7500
  • Fax: 612-377-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP 3712
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: