Organization
PRAIRIE PSYCHOLOGICAL SERVICES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID G JANSEN PH.D. (OWNER AND DIRECTOR)
(218) 281-2117
Entity
Organization
Contact information
Practice address
205 W FLETCHER ST, CROOKSTON, MN 56716-1945
(281) 281-2117
Mailing address
205 W FLETCHER ST, CROOKSTON, MN 56716-1945
(281) 281-2117
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
330748400
—
MN
01
—
6192932
MEDICA
MN
01
—
63658PR
BCBS OF MN
MN
Enumeration date
04/07/2010
Last updated
07/14/2011
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