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NPI Code Detail

MEDICARE: JAMES STANLEY PRIJATEL MS

MEDICARE: JAMES STANLEY PRIJATEL MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC2200XClinical Child & Adolescent PsychologistLP2547MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10268PROTHERBLUE PLUS
256294PROTHERBCBS
36242632OTHERUBH
418800381OTHERMMSI
5484160OTHERVALUE OPTIONS
66242632OTHERMEDICA

General Provider Information

NPI Number : 1194709436
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES STANLEY PRIJATEL MS
Provider Business Mailing Address
First Line : 600 25TH AVE S
Second Line : STE 109
City : SAINT CLOUD
State : MN
Zip : 56301-4841
Country : US
Telephone Number : 320-255-0343
Fax Number : 320-654-0318
Provider Business Practice Location Address
First Line : 600 25TH AVE S
Second Line : STE 109
City : SAINT CLOUD
State : MN
Zip : 56301-4841
Country : US
Telephone Number : 320-255-0343
Fax Number : 320-654-0318
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2005
Last Update Date : 07/08/2007

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1891777496 — JULIE CLAIRE SPARE MS
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1861477234 — MS. JOANNE AGNES KANE LP
Practice Location Address:
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Practice Fax: 320-654-0318

Directions to “ JAMES STANLEY PRIJATEL MS” Practice Location

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