Provider Demographics
NPI:1366864787
Name:BEEK, JAMISON
Entity Type:Individual
Prefix:
First Name:JAMISON
Middle Name:
Last Name:BEEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 E 26TH ST STE 1700
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4514
Mailing Address - Country:US
Mailing Address - Phone:651-241-6332
Mailing Address - Fax:612-863-2930
Practice Address - Street 1:902 E 26TH ST STE 1700
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404
Practice Address - Country:US
Practice Address - Phone:651-241-6332
Practice Address - Fax:612-863-2930
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
170300000X
MN1088170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1366864787Medicaid
MN1518909563Medicaid