Provider Demographics
NPI:1861670804
Name:NELSON, JAMIE LUCILLE (MSW, LICSW, CEAP)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LUCILLE
Last Name:NELSON
Suffix:
Gender:F
Credentials:MSW, LICSW, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 HIGHWAY 100 S
Mailing Address - Street 2:SUITE 430
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1529
Mailing Address - Country:US
Mailing Address - Phone:952-224-9674
Mailing Address - Fax:612-342-2422
Practice Address - Street 1:1660 HIGHWAY 100 S
Practice Address - Street 2:SUITE 430
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-1529
Practice Address - Country:US
Practice Address - Phone:952-224-9674
Practice Address - Fax:612-342-2422
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN136851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical