Provider Demographics
NPI:1376996926
Name:GASNER, JOANN DENISE (LICENSED SOCIAL WORK)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:DENISE
Last Name:GASNER
Suffix:
Gender:F
Credentials:LICENSED SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4655 FREMONT AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412
Mailing Address - Country:US
Mailing Address - Phone:612-200-7344
Mailing Address - Fax:
Practice Address - Street 1:9848 FOLEY BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5617
Practice Address - Country:US
Practice Address - Phone:612-598-4341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1598104100000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1598OtherLICENSED SOCIAL WORKER