Provider Demographics
NPI:1235354531
Name:MANLOVE, JEAN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:
Last Name:MANLOVE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8009 34TH AVE S
Mailing Address - Street 2:SUITE 1490
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1608
Mailing Address - Country:US
Mailing Address - Phone:952-854-5550
Mailing Address - Fax:952-854-5062
Practice Address - Street 1:8009 34TH AVE S
Practice Address - Street 2:SUITE 1490
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1608
Practice Address - Country:US
Practice Address - Phone:952-854-5550
Practice Address - Fax:952-854-5062
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN027441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical