Provider Demographics
NPI:1346550795
Name:GJESFJELD, JOAN ELLEN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:ELLEN
Last Name:GJESFJELD
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 1:704 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-6261
Mailing Address - Country:US
Mailing Address - Phone:309-336-3284
Mailing Address - Fax:
Practice Address - Street 1:1100 BEECH ST
Practice Address - Street 2:BLDG. 13 B
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-1493
Practice Address - Country:US
Practice Address - Phone:309-336-3284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2016-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490161331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical