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General NPI Number Information
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NPI Number | 1922293265
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Entity Type | Organization
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Legal Business Name | JAN JIRAK, MA,LP,PLLC
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 09/10/2007
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Provider Practice Location Address
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Address Line | 314 CLIFTON AVE STE 303
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City | MINNEAPOLIS
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State | MN
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Zip | 55403-3376
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Country | US
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Telephone | 952-985-1097
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Fax |
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Provider Business Mailing Address
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Address Line | 314 CLIFTON AVE STE 303
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City | MINNEAPOLIS
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State | MN
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Zip | 55403-3376
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Country | US
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Telephone | 952-985-1097
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | JAN JIRAK
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Credential | MA,LP
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Telephone | 952-985-1097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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