Provider Demographics
NPI:1164182192
Name:JASPER, STEPHANIE M (PSYD, LP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:JASPER
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 SALEM AVE
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1920
Mailing Address - Country:US
Mailing Address - Phone:612-310-0955
Mailing Address - Fax:
Practice Address - Street 1:7300 METRO BLVD STE 400
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2307
Practice Address - Country:US
Practice Address - Phone:612-425-0094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6739103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist