Provider Demographics
NPI:1215510979
Name:JANSON, STEPHANIE MARGARET LEE (RN, LICSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARGARET LEE
Last Name:JANSON
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Gender:F
Credentials:RN, LICSW
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Mailing Address - Street 1:2700 SNELLING AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1912 8TH ST N
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2078
Practice Address - Country:US
Practice Address - Phone:651-210-4264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical