| Organization Name: | JANET STAM PSY,D, PA |
| NPI Number: | 1992006548 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JANET CAROL STAM (SOLE PROPRIETOR) |
| Mailing Address: | 950 County Road 10 Suite 109 Spring Lake Park |
| State: | MN US |
| Postal Code: | 554321253 |
| Phone Number: | 7637542917 |
| Fax Number: | 7637173088 |
| NPI Enumeration Date: | 11/13/2010 |
| NPI Last Update Date: | 11/13/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | LP4793 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |