Provider Demographics
NPI:1780728782
Name:COFFEY, JANE A (PSYD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:A
Last Name:COFFEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 W 29TH ST
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1977
Mailing Address - Country:US
Mailing Address - Phone:952-926-6514
Mailing Address - Fax:
Practice Address - Street 1:1700 HIGHWAY 36 W
Practice Address - Street 2:516 ROSEDALE TOWERS
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4034
Practice Address - Country:US
Practice Address - Phone:651-631-1090
Practice Address - Fax:612-926-7178
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4230103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical