Provider Demographics
NPI:1235498395
Name:JABLONSKI, JAMIE (LAC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:JABLONSKI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 PLEASANT AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3215
Mailing Address - Country:US
Mailing Address - Phone:773-905-2900
Mailing Address - Fax:
Practice Address - Street 1:8120 PENN AVE S
Practice Address - Street 2:SUITE 158
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-1358
Practice Address - Country:US
Practice Address - Phone:952-955-8483
Practice Address - Fax:952-955-8487
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1590171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist