Individual
JEANETTE LEONE MITCHELL
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MEQ LP
Contact information
Practice address
540 E 1ST ST, WACONIA, MN 55387-1601
(952) 442-4437
(952) 442-3084
Mailing address
540 E 1ST ST, WACONIA, MN 55387-1601
(952) 442-4437
(952) 442-3084
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP2397
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1017126
PREFERRED ONE
MN
01
—
109644
U-CARE
MN
01
—
57428MI
BLUECROSSBLUESHIELD
MN
01
—
6220576
UBH-MEDICA
MN
01
—
HP19051
HEALTH PARTNERS
MN
Enumeration date
08/09/2005
Last updated
07/08/2007
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