Provider Demographics
NPI:1518092642
Name:LEGWOLD, JANE A (RN CNS MSN LMFT)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:A
Last Name:LEGWOLD
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Gender:F
Credentials:RN CNS MSN LMFT
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Mailing Address - Street 1:4601 EXCELSIOR BLVD
Mailing Address - Street 2:SUITE 501D
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416
Mailing Address - Country:US
Mailing Address - Phone:952-926-3744
Mailing Address - Fax:952-926-3735
Practice Address - Street 1:4601 EXCELSIOR BLVD
Practice Address - Street 2:SUITE 501D
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416
Practice Address - Country:US
Practice Address - Phone:952-926-3744
Practice Address - Fax:952-926-3735
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2013-03-06
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Provider Licenses
StateLicense IDTaxonomies
MN0070106H00000X
MNR0794196364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN717755100Medicaid
MN081N5LEOtherBCBS OF MN GRP
MN082N5LEOtherBCBS OF MN IND
MN60068LEOtherBCBS
MN6293312OtherMEDICA