Lisa E. Jack, PH.D., LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

MN 3215 Issued in MN

Practice address

2233 Hamline Ave N Ste 611
Saint Paul, MN 55113-5007

Phone

(651) 455-7333

NPI assigned

Mar 9, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1891827457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2233 HAMLINE AVE N STE 611",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551135007",
            "telephone_number": "651-455-7333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2233 HAMLINE AVE N STE 611",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551135007",
            "telephone_number": "651-455-7333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "LISA",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "PH.D., LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "MN 3215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Casie Iwata, MSW, LICW
• Matthew Iwata, LICSW
• Emily Iwuc, LADC
• Ellen Jabs, D.C.
• Jack B Schaffer PHD PA
• Tremia Jack
• Tamara Jackman
• Jackson Medical Equipment, Inc.
• Jackson Scmitz, PA (Ken Schmitz, LICSW)
• Anitra L Jackson, NP

• Psychologist in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.