Provider Demographics
NPI:1306175443
Name:REED, JASON DEAN (LP)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:DEAN
Last Name:REED
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5354 PARKDALE DR FL 2
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1603
Mailing Address - Country:US
Mailing Address - Phone:651-645-5323
Mailing Address - Fax:952-746-5962
Practice Address - Street 1:3525 MONTEREY DR
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-5275
Practice Address - Country:US
Practice Address - Phone:952-993-0672
Practice Address - Fax:952-993-9970
Is Sole Proprietor?:No
Enumeration Date:2009-12-21
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5410103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)