Provider Demographics
NPI:1316386766
Name:ZAJAC, DENISE EILEEN (LMFT)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:EILEEN
Last Name:ZAJAC
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8519 EAGLE POINT BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042-8629
Mailing Address - Country:US
Mailing Address - Phone:661-249-9450
Mailing Address - Fax:
Practice Address - Street 1:4273 ROSEMARY CT
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-3047
Practice Address - Country:US
Practice Address - Phone:651-249-9450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2957106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist