Provider Demographics
NPI:1235276791
Name:JOSHUA, JANICE CARLSON (PSYD LP)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:CARLSON
Last Name:JOSHUA
Suffix:
Gender:F
Credentials:PSYD LP
Other - Prefix:DR
Other - First Name:JANICE
Other - Middle Name:
Other - Last Name:MAIDMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD LP
Mailing Address - Street 1:5200 WILLSON RD STE 150
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1300
Mailing Address - Country:US
Mailing Address - Phone:952-926-4554
Mailing Address - Fax:952-836-2730
Practice Address - Street 1:5200 WILLSON RD STE 150
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1300
Practice Address - Country:US
Practice Address - Phone:952-926-4554
Practice Address - Fax:952-836-2730
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1361103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN680001686Medicare ID - Type Unspecified
MN995252700Medicare UPIN