Provider Demographics
NPI:1568528156
Name:PAULA J. DETJEN, PLLC
Entity Type:Organization
Organization Name:PAULA J. DETJEN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIC. MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DETJEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:507-581-0430
Mailing Address - Street 1:1000 SUPERIOR DR
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-4873
Mailing Address - Country:US
Mailing Address - Phone:507-581-0430
Mailing Address - Fax:
Practice Address - Street 1:706 DIVISION ST S
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2427
Practice Address - Country:US
Practice Address - Phone:507-581-0430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1399106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN=========-001OtherAMERICA'S PPO