Provider Demographics
NPI:1992852602
Name:VANSICKLE, JANE MARIE (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:MARIE
Last Name:VANSICKLE
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56241-1442
Mailing Address - Country:US
Mailing Address - Phone:612-564-6200
Mailing Address - Fax:
Practice Address - Street 1:345 10TH AVE
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56241-1442
Practice Address - Country:US
Practice Address - Phone:320-564-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2019-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10537101YM0800X
MNLP3973103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health