Provider Demographics
NPI:1588735856
Name:LAWRENZ, JANE MARIE (MA, LP)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:MARIE
Last Name:LAWRENZ
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 WESTERN AVE N
Mailing Address - Street 2:APT 500
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-4601
Mailing Address - Country:US
Mailing Address - Phone:651-224-2331
Mailing Address - Fax:
Practice Address - Street 1:5219 SAINT JOHN DR
Practice Address - Street 2:
Practice Address - City:ORR
Practice Address - State:MN
Practice Address - Zip Code:55771-8232
Practice Address - Country:US
Practice Address - Phone:218-757-3650
Practice Address - Fax:218-757-3650
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0424103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN10D23LAOtherBLUE CROSS & BLUE SHIELD
MN33852300Medicaid
MNHP18507OtherHEALTHPARTNERS