Provider Demographics
NPI:1922293265
Name:JAN JIRAK, MA,LP,PLLC
Entity type:Organization
Organization Name:JAN JIRAK, MA,LP,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JIRAK
Authorized Official - Suffix:
Authorized Official - Credentials:MA,LP
Authorized Official - Phone:952-985-1097
Mailing Address - Street 1:314 CLIFTON AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3376
Mailing Address - Country:US
Mailing Address - Phone:952-985-1097
Mailing Address - Fax:
Practice Address - Street 1:314 CLIFTON AVE STE 303
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3376
Practice Address - Country:US
Practice Address - Phone:952-985-1097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty