Provider Demographics
NPI:1477537355
Name:DEFRANCISCO, JOHN (MS,MA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:DEFRANCISCO
Suffix:
Gender:M
Credentials:MS,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 1ST AVE NE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5268
Mailing Address - Country:US
Mailing Address - Phone:507-332-8082
Mailing Address - Fax:
Practice Address - Street 1:303 1ST AVE NE
Practice Address - Street 2:SUITE 220
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5268
Practice Address - Country:US
Practice Address - Phone:507-332-8082
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0411103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical