Provider Demographics
NPI:1114042819
Name:TRUCHSESS, JEANETTE ELAINE (PHD LP)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:ELAINE
Last Name:TRUCHSESS
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 1:348 PRIOR AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104
Mailing Address - Country:US
Mailing Address - Phone:651-226-4704
Mailing Address - Fax:
Practice Address - Street 1:348 PRIOR AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-226-4704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2049103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6129933OtherUNITED BEHAVIORAL HEALTH
MN3K724TROtherBLUE CROSS