Provider Demographics
NPI:1902822380
Name:LAW, MARJORIE (PHD, LP)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:LAW
Suffix:
Gender:F
Credentials:PHD, LP
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Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 BANDANA BLVD E
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-5113
Mailing Address - Country:US
Mailing Address - Phone:651-642-2700
Mailing Address - Fax:651-642-9441
Practice Address - Street 1:1295 BANDANA BLVD N
Practice Address - Street 2:SUITE 142
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-5126
Practice Address - Country:US
Practice Address - Phone:651-641-7062
Practice Address - Fax:651-641-7196
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP2943103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN020227400Medicaid