Provider Demographics
NPI:1891204103
Name:MOHNKERN, JAEL LAINE (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:JAEL
Middle Name:LAINE
Last Name:MOHNKERN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:J. LAINE
Other - Middle Name:
Other - Last Name:MOHNKERN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:771 RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1522
Mailing Address - Country:US
Mailing Address - Phone:612-235-6743
Mailing Address - Fax:612-524-5527
Practice Address - Street 1:771 RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1522
Practice Address - Country:US
Practice Address - Phone:612-235-6743
Practice Address - Fax:612-524-5527
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN213211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty