1518092642 NPI number — MS. JANE A LEGWOLD RN CNS MSN LMFT

Table of content: MS. JANE A LEGWOLD RN CNS MSN LMFT (NPI 1518092642)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518092642 NPI number — MS. JANE A LEGWOLD RN CNS MSN LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEGWOLD
Provider First Name:
JANE
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN CNS MSN LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518092642
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4601 EXCELSIOR BLVD
Provider Second Line Business Mailing Address:
SUITE 501D
Provider Business Mailing Address City Name:
ST LOUIS PARK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-926-3744
Provider Business Mailing Address Fax Number:
952-926-3735

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4601 EXCELSIOR BLVD
Provider Second Line Business Practice Location Address:
SUITE 501D
Provider Business Practice Location Address City Name:
ST LOUIS PARK
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-926-3744
Provider Business Practice Location Address Fax Number:
952-926-3735
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  0070 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364S00000X , with the licence number: R0794196 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 717755100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 081N5LE . This is a "BCBS OF MN GRP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 082N5LE . This is a "BCBS OF MN IND" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 60068LE . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6293312 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com