Provider Demographics
NPI:1194709436
Name:PRIJATEL, JAMES STANLEY (MS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:STANLEY
Last Name:PRIJATEL
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 25TH AVE S
Mailing Address - Street 2:STE 109
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4841
Mailing Address - Country:US
Mailing Address - Phone:320-255-0343
Mailing Address - Fax:320-654-0318
Practice Address - Street 1:600 25TH AVE S
Practice Address - Street 2:STE 109
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4841
Practice Address - Country:US
Practice Address - Phone:320-255-0343
Practice Address - Fax:320-654-0318
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2547103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
0268PROtherBLUE PLUS
56294PROtherBCBS
6242632OtherUBH
18800381OtherMMSI
484160OtherVALUE OPTIONS
6242632OtherMEDICA