Basic Information
| Provider Information | |||||||||
| NPI: | 1699735183 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRAUS | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PRAUS | ||||||||
| OtherFirstName: | DOUGLAS | ||||||||
| OtherMiddleName: | JAMES | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1919 UNIVERSIT AVE W. | ||||||||
| Address2: | STE 200 | ||||||||
| City: | ST. PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551043453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512667999 | ||||||||
| FaxNumber: | 6512667850 | ||||||||
| Practice Location | |||||||||
| Address1: | 1919 UNIVERSITY AVE W. | ||||||||
| Address2: | STE 200 | ||||||||
| City: | ST PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551043453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512667999 | ||||||||
| FaxNumber: | 6512667850 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 08/01/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 042805E | PA | N | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | 28946 | IA | N | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | 18062 | NE | N | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | 42241 | MN | N | Behavioral Health & Social Service Providers | Psychologist | 2084P0800X | 42241 | MN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.