Provider Demographics
NPI:1225763253
Name:NORSTREM, JENNIFER (LISW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:NORSTREM
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5788 FRANKLIN CT
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MN
Mailing Address - Zip Code:55092-8104
Mailing Address - Country:US
Mailing Address - Phone:612-710-2310
Mailing Address - Fax:
Practice Address - Street 1:5788 FRANKLIN CT
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MN
Practice Address - Zip Code:55092-8104
Practice Address - Country:US
Practice Address - Phone:612-710-2310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3704081041S0200X
MN13414104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool