Provider Demographics
NPI:1639403967
Name:WERE, JAEL
Entity Type:Individual
Prefix:
First Name:JAEL
Middle Name:
Last Name:WERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5280 ANNAPOLIS LN N
Mailing Address - Street 2:3330
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-3614
Mailing Address - Country:US
Mailing Address - Phone:762-221-4018
Mailing Address - Fax:
Practice Address - Street 1:2127 COUNTY ROAD D E STE A
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-5349
Practice Address - Country:US
Practice Address - Phone:651-592-1592
Practice Address - Fax:651-429-2988
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1788106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist