Colaizy, Jackie M

Colaizy, Jackie M is an individual health care provider with primary practice located at 1900 Silver Lake Road Nw Suite 110, New Brighton MN 55112. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Colaizy, Jackie M can be contacted via phone (651) 628-9566.

Contact Information

Primary practice address
1900 Silver Lake Road Nw Suite 110 New Brighton MN 55112
Phone: (651) 628-9566
Fax: (651) 628-0411
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 1727 Minnesota

Profile Details

NPI number 1265493167
LBN Legal business name Colaizy, Jackie M
Credentials LICSW
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 30th, 2006
Last updated Apr 13th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265493167 NPPES
Minnesota MEDICAID 320477400

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