Provider Demographics
NPI:1609395904
Name:JAEGER, LISA MAE (LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MAE
Last Name:JAEGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66139 145TH AVE
Mailing Address - Street 2:
Mailing Address - City:WABASHA
Mailing Address - State:MN
Mailing Address - Zip Code:55981-7614
Mailing Address - Country:US
Mailing Address - Phone:651-560-0016
Mailing Address - Fax:888-972-4451
Practice Address - Street 1:66139 145TH AVE
Practice Address - Street 2:
Practice Address - City:WABASHA
Practice Address - State:MN
Practice Address - Zip Code:55981-7614
Practice Address - Country:US
Practice Address - Phone:651-560-0016
Practice Address - Fax:888-972-4451
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02011101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty