Provider Demographics
NPI:1922160217
Name:E.JANE LORENTZEN, PSY.D., L.P., P.A.
Entity Type:Organization
Organization Name:E.JANE LORENTZEN, PSY.D., L.P., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:LORENTZEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:651-388-0133
Mailing Address - Street 1:325 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-2356
Mailing Address - Country:US
Mailing Address - Phone:651-388-0133
Mailing Address - Fax:651-388-1252
Practice Address - Street 1:325 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-2356
Practice Address - Country:US
Practice Address - Phone:651-388-0133
Practice Address - Fax:651-388-1252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 4208261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center