Healthcare Provider Details

I. General information

NPI: 1649631656
Provider Name (Legal Business Name): JAYNE LOKKEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 25TH AVE S SUITE 109
SAINT CLOUD MN
56301-4841
US

IV. Provider business mailing address

600 25TH AVE S SUITE 109
SAINT CLOUD MN
56301-4841
US

V. Phone/Fax

Practice location:
  • Phone: 320-255-0343
  • Fax:
Mailing address:
  • Phone: 320-255-0343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLP4377
License Number StateMN

VIII. Authorized Official

Name: JAYNE LOKKEN
Title or Position: PSYCHOLOGIST
Credential: PH.D., LP
Phone: 320-255-0343