Provider Demographics
NPI:1376770941
Name:SAWYER, JEBEDIAH JOEL (MA)
Entity Type:Individual
Prefix:MR
First Name:JEBEDIAH
Middle Name:JOEL
Last Name:SAWYER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 MINNETONKA BLVD APT 308
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5417
Mailing Address - Country:US
Mailing Address - Phone:612-483-4994
Mailing Address - Fax:
Practice Address - Street 1:4820 MINNETONKA BLVD STE 411
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-5710
Practice Address - Country:US
Practice Address - Phone:612-483-4994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00232101YP2500X
MN1449106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN154H5BEOtherBLUE CROSS BLUE SHIELD