Provider Demographics
NPI:1619100138
Name:JAEGER, KERRI SHEAR (MA, LP)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:SHEAR
Last Name:JAEGER
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10560 WAYZATA BLVD STE 5
Mailing Address - Street 2:WOODSIDE OFFICE PARK, BLDG 2
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1665
Mailing Address - Country:US
Mailing Address - Phone:612-598-0362
Mailing Address - Fax:
Practice Address - Street 1:10560 WAYZATA BLVD
Practice Address - Street 2:WOODSIDE OFFICE PARK, BLDG 2, SUITE 5
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1524
Practice Address - Country:US
Practice Address - Phone:612-598-0362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2010-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3383103T00000X, 103TB0200X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral