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General NPI Number Information
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NPI Number | 1164635975
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Entity Type | Individual
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Provider Name | JOHN ALAN STOLTZFUS PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 521 TANGLEWOOD DRIVE
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City | SHOREVIEW
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State | MN
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Zip | 55126
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Country | US
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Telephone | 651-486-0122
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Fax | 651-490-5215
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Provider Business Mailing Address
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Address Line | 4500 FOOTHILL TRAIL
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City | VADNAIS HEIGHTS
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State | MN
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Zip | 55127
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Country | US
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Telephone | 651-481-4997
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Fax | 651-490-5215
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP2280
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License Number State | MN
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