Provider Demographics
NPI:1780668459
Name:KILGRIFF, JANE M (MA, LP)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:M
Last Name:KILGRIFF
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 LEXINGTON AVE S
Mailing Address - Street 2:#7
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-3624
Mailing Address - Country:US
Mailing Address - Phone:651-503-9931
Mailing Address - Fax:
Practice Address - Street 1:5200 WILLSON RD
Practice Address - Street 2:#309
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1332
Practice Address - Country:US
Practice Address - Phone:651-503-9931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2595103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling