Provider Demographics
NPI:1093928681
Name:MERSHON, JAN DELAINE (MS)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:DELAINE
Last Name:MERSHON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 W 44TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1032
Mailing Address - Country:US
Mailing Address - Phone:952-922-1977
Mailing Address - Fax:952-922-1980
Practice Address - Street 1:3919 W 44TH ST STE 200
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55424-1032
Practice Address - Country:US
Practice Address - Phone:952-922-1977
Practice Address - Fax:952-922-1980
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor