Individual
JANE WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
1130 NICOLLET AVE, MINNEAPOLIS, MN 55403-2405
(763) 689-5385
Mailing address
1449 LAKEVIEW AVE S, MINNEAPOLIS, MN 55416-3612
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6130
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
058K2WI
BCBS
MN
01
—
4600666
MEDICA
MN
01
—
HP46019
HEALTH PARTNERS
MN
Enumeration date
10/19/2006
Last updated
07/09/2007
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