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NPI Code Detail

MEDICARE: STACEY JUNGHANS M.A., LP

MEDICARE: STACEY JUNGHANS M.A., 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
1103T00000XPsychologist4106MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21022878OTHERMNP1
362-62375OTHERMNUBH
4124596OTHERMNUC
520D41JUOTHERMNBCBS
630594OTHERMNHP

General Provider Information

NPI Number : 1396759585
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY JUNGHANS M.A., LP
Provider Business Mailing Address
First Line : 8170 33RD AVE S
Second Line : MS 21110Q
City : BLOOMINGTON
State : MN
Zip : 55425-4516
Country : US
Telephone Number : 651-552-2600
Fax Number : 651-552-2614
Provider Business Practice Location Address
First Line : 5625 CENEX DR
Second Line :
City : INVER GROVE HEIGHTS
State : MN
Zip : 55077-1724
Country : US
Telephone Number : 651-552-2600
Fax Number : 651-552-2614
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 11/02/2016

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