Provider Demographics
NPI:1104158195
Name:HOISTAD, JAN (PHD LP)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:
Last Name:HOISTAD
Suffix:
Gender:F
Credentials:PHD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 PARK CENTER BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2524
Mailing Address - Country:US
Mailing Address - Phone:952-922-9430
Mailing Address - Fax:952-426-1741
Practice Address - Street 1:4433 DUNHAM DR
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4139
Practice Address - Country:US
Practice Address - Phone:952-416-1922
Practice Address - Fax:952-426-1741
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2675103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist