Individual
DR. LISA E. JACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D., LP
Contact information
Practice address
2233 HAMLINE AVE N STE 611, SAINT PAUL, MN 55113-5007
(651) 455-7333
Mailing address
2233 HAMLINE AVE N STE 611, SAINT PAUL, MN 55113-5007
(651) 455-7333
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
MN 3215
MN
Other
Enumeration date
03/09/2007
Last updated
07/08/2007
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