Provider Demographics
NPI:1881760940
Name:GREGOR, JENNIFER ANN VERMEER (MSW, LICSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN VERMEER
Last Name:GREGOR
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:VERMEER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LMSW
Mailing Address - Street 1:2620 HAMPSHIRE AVE S
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-3356
Mailing Address - Country:US
Mailing Address - Phone:646-505-8846
Mailing Address - Fax:
Practice Address - Street 1:2540 COUNTY ROAD F E
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3935
Practice Address - Country:US
Practice Address - Phone:651-415-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN198081041C0700X, 1041S0200X
NY071275-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool