Healthcare Provider Details

I. General information

NPI: 1679896682
Provider Name (Legal Business Name): JANEY DORGAN NELSON M.A., LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 PARK GLEN RD SUITE 155
ST LOUIS PARK MN
55416-4871
US

IV. Provider business mailing address

4500 PARK GLEN RD SUITE 155
ST LOUIS PARK MN
55416-4871
US

V. Phone/Fax

Practice location:
  • Phone: 952-472-2408
  • Fax: 952-495-1409
Mailing address:
  • Phone: 952-472-2408
  • Fax: 952-495-1409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW3035
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: