Healthcare Provider Details

I. General information

NPI: 1912279019
Provider Name (Legal Business Name): DR. JANICE NADEAU, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 WILLOW ST SUITE 300
MINNEAPOLIS MN
55403-2269
US

IV. Provider business mailing address

1409 WILLOW ST SUITE 300
MINNEAPOLIS MN
55403-2269
US

V. Phone/Fax

Practice location:
  • Phone: 612-870-1244
  • Fax: 612-870-8077
Mailing address:
  • Phone: 612-870-1244
  • Fax: 612-870-8077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2807
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0787
License Number StateMN

VIII. Authorized Official

Name: DR. JANICE MARIE NADEAU
Title or Position: PSYCHOTHERAPIST
Credential: LP
Phone: 612-870-1242