Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | LP3786 | MN |
N | 103TC0700X | Clinical Psychologist | LP3786 | MN |
Y | 103TC1900X | Counseling Psychologist | 3786 | MN |
NPI | 1033193172 |
---|---|
Provider Name | Ms. Laura Ann Jaap |
First Address | Minnetonka, MN 55343-4157 |
Second Address | Minnetonka, MN 55343-4157 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 01/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033193172 | (05) | MN |
946324100 | (05) | MN |