Provider Demographics
NPI:1679587992
Name:GRESETH KIRCHNER, JEAN IRENE (MSW)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:IRENE
Last Name:GRESETH KIRCHNER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:IRENE
Other - Last Name:GRESETH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:515 BRIDGE STREET EAST
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-1810
Mailing Address - Country:US
Mailing Address - Phone:218-366-9229
Mailing Address - Fax:218-237-2520
Practice Address - Street 1:515 BRIDGE STREET EAST
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1810
Practice Address - Country:US
Practice Address - Phone:218-366-9229
Practice Address - Fax:218-237-2520
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN038551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7528574-00Medicaid
MN7528574-00Medicaid
MN6253229Medicare UPIN