Healthcare Provider Details

I. General information

NPI: 1396698080
Provider Name (Legal Business Name): JASON KURTZ NCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2026
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 W BROADWAY AVE
MINNEAPOLIS MN
55411-2533
US

IV. Provider business mailing address

1250 W BROADWAY AVE
MINNEAPOLIS MN
55411-2533
US

V. Phone/Fax

Practice location:
  • Phone: 612-668-0254
  • Fax:
Mailing address:
  • Phone: 612-668-0254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number455770
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: