Provider Demographics
NPI:1891279667
Name:KONECNY, JARED (LICSW)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:KONECNY
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1934 W KENT RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-1154
Mailing Address - Country:US
Mailing Address - Phone:218-730-8440
Mailing Address - Fax:
Practice Address - Street 1:1934 W KENT RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-1154
Practice Address - Country:US
Practice Address - Phone:218-730-8440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011005951041C0700X
MN292971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical