Provider Demographics
NPI:1083846547
Name:JEAN M BJERKE, PA
Entity Type:Organization
Organization Name:JEAN M BJERKE, PA
Other - Org Name:MARKET PLACE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BJERKE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LICSW
Authorized Official - Phone:320-253-4080
Mailing Address - Street 1:110 2ND ST S
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1662
Mailing Address - Country:US
Mailing Address - Phone:320-253-4080
Mailing Address - Fax:320-253-4088
Practice Address - Street 1:110 2ND ST S
Practice Address - Street 2:SUITE 303
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1662
Practice Address - Country:US
Practice Address - Phone:320-253-4080
Practice Address - Fax:320-253-4088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN80261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN171093128Medicare UPIN