Provider Demographics
NPI:1710931928
Name:BJERKE, JEAN M (MA, LICSW)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:BJERKE
Suffix:
Gender:F
Credentials:MA, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 2ND ST S
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1662
Mailing Address - Country:US
Mailing Address - Phone:320-253-4080
Mailing Address - Fax:320-253-4088
Practice Address - Street 1:110 2ND ST S
Practice Address - Street 2:SUITE 303
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1662
Practice Address - Country:US
Practice Address - Phone:320-253-4080
Practice Address - Fax:320-253-4088
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN80261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical