Provider Demographics
NPI:1598724957
Name:ROOT, JANET ANN (MS LMFT)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:ANN
Last Name:ROOT
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:A
Other - Last Name:ROOT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-7961
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:5100 GAMBLE DR
Practice Address - Street 2:STE 100 MAIL STOP 31200A
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1582
Practice Address - Country:US
Practice Address - Phone:952-593-8777
Practice Address - Fax:952-595-6475
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0651093106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist