Provider Demographics
NPI:1679160717
Name:MILBRATH, JESSICA LAUREE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LAUREE
Last Name:MILBRATH
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 1:5406 NOKOMIS AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2061
Mailing Address - Country:US
Mailing Address - Phone:651-380-3723
Mailing Address - Fax:
Practice Address - Street 1:2324 UNIVERSITY AVE W STE 120
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1854
Practice Address - Country:US
Practice Address - Phone:651-644-4100
Practice Address - Fax:651-644-4885
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27291104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker