Healthcare Provider Details

I. General information

NPI: 1922293265
Provider Name (Legal Business Name): JAN JIRAK, MA,LP,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 CLIFTON AVE STE 303
MINNEAPOLIS MN
55403-3376
US

IV. Provider business mailing address

314 CLIFTON AVE STE 303
MINNEAPOLIS MN
55403-3376
US

V. Phone/Fax

Practice location:
  • Phone: 952-985-1097
  • Fax:
Mailing address:
  • Phone: 952-985-1097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JAN JIRAK
Title or Position: LICENSED PSYCHOLOGIST
Credential: MA,LP
Phone: 952-985-1097