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Individual

MRS. JANE HARRIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MA LP

Contact information

Practice address
3131 FERNBROOK LN N, SUITE 102, PLYMOUTH, MN 55447-5321
(612) 839-7975
Mailing address
15840 ELODIE LN, MINNETONKA, MN 55345-4545
(612) 839-7975

Taxonomy

Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
LP3146
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
664817700
MN
Enumeration date
06/27/2006
Last updated
04/10/2012
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