Provider Demographics
NPI:1750693263
Name:ALLEN, JANE LEE (PHD LP)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:LEE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PHD LP
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:LEE
Other - Last Name:KUSESKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD LP
Mailing Address - Street 1:5710 BAKER ROAD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345
Mailing Address - Country:US
Mailing Address - Phone:952-767-4200
Mailing Address - Fax:952-767-4211
Practice Address - Street 1:5710 BAKER ROAD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345
Practice Address - Country:US
Practice Address - Phone:952-767-4200
Practice Address - Fax:952-767-4211
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00120101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional