Provider Demographics
NPI:1518294032
Name:BLUEM, JACQUELINE (BCC, LADC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BLUEM
Suffix:
Gender:F
Credentials:BCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7580 160TH STREET WEST
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044
Mailing Address - Country:US
Mailing Address - Phone:651-356-2938
Mailing Address - Fax:
Practice Address - Street 1:7580 160TH STREET WEST
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044
Practice Address - Country:US
Practice Address - Phone:612-871-0118
Practice Address - Fax:612-870-2403
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302710101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)