Provider Demographics
NPI:1609329234
Name:FORSBERG, JON D (MA)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:D
Last Name:FORSBERG
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 1:5155 E RIVER RD STE 401
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55421-3777
Mailing Address - Country:US
Mailing Address - Phone:763-438-4038
Mailing Address - Fax:763-780-3306
Practice Address - Street 1:5155 E RIVER RD STE 401
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55421-3777
Practice Address - Country:US
Practice Address - Phone:763-438-4038
Practice Address - Fax:763-780-3306
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health