Provider Demographics
NPI:1952015091
Name:OLEARY, JERESSA (MA)
Entity Type:Individual
Prefix:
First Name:JERESSA
Middle Name:
Last Name:OLEARY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8330 FREMONT AVE S APT 100
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-2153
Mailing Address - Country:US
Mailing Address - Phone:612-280-0668
Mailing Address - Fax:
Practice Address - Street 1:8330 FREMONT AVE S APT 100
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-2153
Practice Address - Country:US
Practice Address - Phone:651-503-9868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health