Provider Demographics
NPI:1811962871
Name:LORENTZEN, ELIZABETH JANE (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:JANE
Last Name:LORENTZEN
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 1:325 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066
Mailing Address - Country:US
Mailing Address - Phone:651-388-0133
Mailing Address - Fax:651-388-1252
Practice Address - Street 1:325 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066
Practice Address - Country:US
Practice Address - Phone:651-388-0133
Practice Address - Fax:651-388-1252
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4208103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist