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General NPI Number Information
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NPI Number | 1144269028
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Entity Type | Individual
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Provider Name | JANE STEWART ROZNOVSKY PHD LP
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Gender | Female
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 5706 HYLAND COURTS DR
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City | BLOOMINGTON
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State | MN
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Zip | 55437-1933
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Country | US
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Telephone | 952-893-1155
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 65
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City | MUSE
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State | OK
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Zip | 74949-0065
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Country | US
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Telephone | 918-651-3570
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP0308
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License Number State | MN
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