| Doctor Name: | JANE ELLA PHELPS |
| NPI Number: | 1023457033 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LADC |
| License Number: | 302439 |
| Business Practice Address: | 722 15th St Nw Bemidji, MN - 566012528 |
| Business Phone Number: | 2187513280 |
| Business Fax Number: | |
| Mailing Address: | 841 Doberman Ct Se, Apt 203 BEMIDJI |
| State: | MN |
| Postal Code: | 566013567 |
| Phone Number: | 2185569948 |
| Fax Number: | |
| NPI Enumeration Date: | 06/24/2013 |
| NPI Last Update Date: | 06/24/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 302439 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |