Provider Demographics
NPI:1104824234
Name:HARKINS-CRAVEN, JO ANNE (PHD)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:ANNE
Last Name:HARKINS-CRAVEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 HIGHWAY 96 E
Mailing Address - Street 2:SUITE 104C
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3624
Mailing Address - Country:US
Mailing Address - Phone:612-203-8654
Mailing Address - Fax:651-762-3780
Practice Address - Street 1:1310 HIGHWAY 96 E
Practice Address - Street 2:SUITE 104C
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3624
Practice Address - Country:US
Practice Address - Phone:612-203-8654
Practice Address - Fax:651-762-3780
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2119103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN41M25HAOtherBLUECROSS&BLUESHIELD ID
MNHP26603OtherHEALTHPARTNERS ID
MN1101299OtherCIGNA BEHAVIORAL ID
MN101771OtherUCARE ID
MN20244OtherBEHAVIORAL HEALTHCARE PRO
MN61-71156OtherUNITED BEHAVIORAL ID