Provider Demographics
NPI:1689727984
Name:DOLEJSI, MARY ELIZABETH (LP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:DOLEJSI
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 JAMES AVE S
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2533
Mailing Address - Country:US
Mailing Address - Phone:612-377-7500
Mailing Address - Fax:612-377-7501
Practice Address - Street 1:3005 JAMES AVE S
Practice Address - Street 2:SUITE 103
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2533
Practice Address - Country:US
Practice Address - Phone:612-377-7500
Practice Address - Fax:612-377-7501
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 3712103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist