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NPI Code Detail

MEDICARE: DR. JESSICA B COHEN LP

MEDICARE: DR. JESSICA B COHEN LP
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
1103TC0700XClinical Psychologist3905MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336231448
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JESSICA B COHEN LP
Provider Business Mailing Address
First Line : 1100 GLENWOOD AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55405-1430
Country : US
Telephone Number : 612-871-1454
Fax Number : 612-871-1505
Provider Business Practice Location Address
First Line : 1100 GLENWOOD AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55405-1430
Country : US
Telephone Number : 612-871-1454
Fax Number : 612-871-1505
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 12/03/2014

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