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Individual

JANE RANDOLPH ELLISON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LMFT

Contact information

Practice address
32104 COUNTY ROAD 1, SAINT CLOUD, MN 56303-9534
(320) 654-0001
(320) 654-0002
Mailing address
32104 COUNTY ROAD 1, SAINT CLOUD, MN 56303-9534
(320) 654-0001
(320) 654-0002

Taxonomy

Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
1428
MN

Other

Enumeration date
09/24/2009
Last updated
09/24/2009
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