Provider Demographics
NPI:1689298903
Name:JABLONSKI, PAIGE (PSYD, LP)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:JABLONSKI
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1876 MINNEHAHA AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1029
Mailing Address - Country:US
Mailing Address - Phone:612-460-0083
Mailing Address - Fax:
Practice Address - Street 1:6230 10TH ST N STE 120
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-6159
Practice Address - Country:US
Practice Address - Phone:612-460-0083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7019103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist