Provider Demographics
NPI:1457986556
Name:ENGFER, JON BROOKSON (MPS LADC CPRS)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:BROOKSON
Last Name:ENGFER
Suffix:
Gender:M
Credentials:MPS LADC CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 SOUTHCROSS DRIVE EAST
Mailing Address - Street 2:
Mailing Address - City:BRUNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306
Mailing Address - Country:US
Mailing Address - Phone:612-443-0142
Mailing Address - Fax:
Practice Address - Street 1:8609 LYNDALE AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420
Practice Address - Country:US
Practice Address - Phone:952-358-1009
Practice Address - Fax:612-424-0906
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305576101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor