Provider Demographics
NPI:1386997179
Name:RAFFERTY, JADE BENDER (PHD, LP)
Entity type:Individual
Prefix:DR
First Name:JADE
Middle Name:BENDER
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:DR
Other - First Name:JADE
Other - Middle Name:ANDROMEDA
Other - Last Name:BENDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LP
Mailing Address - Street 1:2720 W 43RD ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-1643
Mailing Address - Country:US
Mailing Address - Phone:612-767-9860
Mailing Address - Fax:612-767-9861
Practice Address - Street 1:2720 W 43RD ST
Practice Address - Street 2:SUITE 205
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-1643
Practice Address - Country:US
Practice Address - Phone:612-767-9860
Practice Address - Fax:612-767-9861
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent