Healthcare Provider Details

I. General information

NPI: 1194709436
Provider Name (Legal Business Name): JAMES STANLEY PRIJATEL MS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 320-255-0343
  • Fax: 320-654-0318
Mailing address:
  • Phone: 320-255-0343
  • Fax: 320-654-0318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberLP2547
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: