Provider Demographics
NPI:1144269028
Name:ROZNOVSKY, JANE STEWART (PHD LP)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:STEWART
Last Name:ROZNOVSKY
Suffix:
Gender:F
Credentials:PHD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:MUSE
Mailing Address - State:OK
Mailing Address - Zip Code:74949-0065
Mailing Address - Country:US
Mailing Address - Phone:918-651-3570
Mailing Address - Fax:
Practice Address - Street 1:5706 HYLAND COURTS DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-1933
Practice Address - Country:US
Practice Address - Phone:952-893-1155
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0308103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNRJ2470Medicare UPIN