Provider Demographics
NPI:1881978559
Name:VITELLI, JOANN FRANCES (LP)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:FRANCES
Last Name:VITELLI
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 E PEARSON AVE
Mailing Address - Street 2:
Mailing Address - City:NASHWAUK
Mailing Address - State:MN
Mailing Address - Zip Code:55769-1146
Mailing Address - Country:US
Mailing Address - Phone:218-301-1010
Mailing Address - Fax:218-214-9889
Practice Address - Street 1:430 E PEARSON AVE
Practice Address - Street 2:
Practice Address - City:NASHWAUK
Practice Address - State:MN
Practice Address - Zip Code:55769-1146
Practice Address - Country:US
Practice Address - Phone:218-301-1010
Practice Address - Fax:218-214-9889
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5897103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical