Individual
DR. MARY JANE WHITESIDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, LP
Contact information
Practice address
217 PLUM ST, SUITE 140, RED WING, MN 55066-2351
(651) 388-4302
(651) 385-9052
Mailing address
217 PLUM ST, SUITE 140, RED WING, MN 55066-2351
(651) 388-4302
(651) 385-9052
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP3361
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
(NO NUMBER)
MMSI (MAYO)
MN
01
—
1027089
PREFERREDONE
MN
01
—
108480
HEALTHPARTNERS
MN
01
—
132T7WH
BLUECROSS BLUESHIELD(GRP)
MN
01
—
132T8WH
BLUECROSS BLUESHIELD(IND)
MN
01
—
167752
UCARE
MN
01
—
61-68825
UNITED BEHAVIORAL HEALTH
MN
Enumeration date
11/24/2006
Last updated
07/08/2007
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