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General NPI Number Information
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NPI Number | 1922160217
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Entity Type | Organization
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Legal Business Name | E.JANE LORENTZEN, PSY.D., L.P., P.A.
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 325 MAIN ST SUITE 201
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City | RED WING
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State | MN
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Zip | 55066-2356
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Country | US
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Telephone | 651-388-0133
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Fax | 651-388-1252
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Provider Business Mailing Address
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Address Line | 325 MAIN ST SUITE 201
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City | RED WING
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State | MN
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Zip | 55066-2356
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Country | US
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Telephone | 651-388-0133
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Fax | 651-388-1252
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELIZABETH JANE LORENTZEN
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Credential | PSY.D.
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Telephone | 651-388-0133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | LP 4208
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License Number State | MN
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