Provider Demographics
NPI:1609167774
Name:GREGOIRE, JENNIFER JOANN (LICSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOANN
Last Name:GREGOIRE
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 1:1400 E LYON ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-2502
Mailing Address - Country:US
Mailing Address - Phone:507-537-7899
Mailing Address - Fax:507-537-7950
Practice Address - Street 1:1400 E LYON ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-2502
Practice Address - Country:US
Practice Address - Phone:507-537-7899
Practice Address - Fax:507-537-7950
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN17355101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional