Provider Demographics
NPI:1922605823
Name:ANDREW-JAJA, DENA SAGE (MSW LGSW)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:SAGE
Last Name:ANDREW-JAJA
Suffix:
Gender:F
Credentials:MSW LGSW
Other - Prefix:
Other - First Name:DENA
Other - Middle Name:JAJA
Other - Last Name:SAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DENA SAGE MSW, LGSW
Mailing Address - Street 1:680 GAME FARM RD N
Mailing Address - Street 2:
Mailing Address - City:MINNETRISTA
Mailing Address - State:MN
Mailing Address - Zip Code:55359-9493
Mailing Address - Country:US
Mailing Address - Phone:952-491-0589
Mailing Address - Fax:
Practice Address - Street 1:680 GAME FARM RD N
Practice Address - Street 2:
Practice Address - City:MINNETRISTA
Practice Address - State:MN
Practice Address - Zip Code:55359-9493
Practice Address - Country:US
Practice Address - Phone:952-491-0589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-04
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22309101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN22309OtherSOCIAL WORK LICENSE