Provider Demographics
NPI:1992006548
Name:JANET STAM PSY,D, PA
Entity Type:Organization
Organization Name:JANET STAM PSY,D, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:STAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-754-2917
Mailing Address - Street 1:950 COUNTY ROAD 10
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SPRING LAKE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55432-1253
Mailing Address - Country:US
Mailing Address - Phone:763-754-2917
Mailing Address - Fax:763-717-3088
Practice Address - Street 1:950 COUNTY ROAD 10
Practice Address - Street 2:SUITE 109
Practice Address - City:SPRING LAKE PARK
Practice Address - State:MN
Practice Address - Zip Code:55432-1253
Practice Address - Country:US
Practice Address - Phone:763-754-2917
Practice Address - Fax:763-717-3088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-13
Last Update Date:2010-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4793103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty