Provider Demographics
NPI:1386775278
Name:EGAN, LOIS JAYNE (LICSW)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:JAYNE
Last Name:EGAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 UPTON AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-1240
Mailing Address - Country:US
Mailing Address - Phone:612-821-9112
Mailing Address - Fax:612-377-7501
Practice Address - Street 1:3005 JAMES AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2533
Practice Address - Country:US
Practice Address - Phone:612-821-9112
Practice Address - Fax:612-377-7501
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN149021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical