Provider Demographics
NPI:1811406945
Name:ELMBERG, JENNIFER ROSE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSE
Last Name:ELMBERG
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 1:306 W SUPERIOR ST STE 1000
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1818
Mailing Address - Country:US
Mailing Address - Phone:218-481-7660
Mailing Address - Fax:218-216-1452
Practice Address - Street 1:225 1ST ST N STE 3100B
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2457
Practice Address - Country:US
Practice Address - Phone:218-481-7660
Practice Address - Fax:218-216-1452
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN258701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical