Provider Demographics
NPI:1740901032
Name:TIM JANDRO PSYCHOLOGICAL SERVICES PLLC
Entity type:Organization
Organization Name:TIM JANDRO PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:D
Authorized Official - Last Name:JANDRO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LP
Authorized Official - Phone:612-508-9060
Mailing Address - Street 1:14525 HIGHWAY 7 STE 310
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-3734
Mailing Address - Country:US
Mailing Address - Phone:612-508-9060
Mailing Address - Fax:
Practice Address - Street 1:14525 HIGHWAY 7 STE 310
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-3734
Practice Address - Country:US
Practice Address - Phone:612-508-9060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty