Provider Demographics
NPI:1851439178
Name:HOLLIS, JANE MARY (MA, LP)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:MARY
Last Name:HOLLIS
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 1:311 RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2323
Mailing Address - Country:US
Mailing Address - Phone:651-602-0334
Mailing Address - Fax:651-454-2412
Practice Address - Street 1:311 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2323
Practice Address - Country:US
Practice Address - Phone:651-602-0334
Practice Address - Fax:651-454-2412
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3956103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist