Provider Demographics
NPI:1255704490
Name:OLIVIA JEWETT THERAPY, LLC.
Entity type:Organization
Organization Name:OLIVIA JEWETT THERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:INGALLS
Authorized Official - Last Name:JEWETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-492-3298
Mailing Address - Street 1:7525 MITCHELL RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-1959
Mailing Address - Country:US
Mailing Address - Phone:320-492-3298
Mailing Address - Fax:
Practice Address - Street 1:5200 WILSON RD.
Practice Address - Street 2:SUITE 450
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1396
Practice Address - Country:US
Practice Address - Phone:320-492-3298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty