Jeanetta Wark, Jeffry David

Jeanetta Wark, Jeffry David is an sole proprietor health care provider with primary practice located at 1751 County Road B W Ste 100 , Roseville MN 55113-4037. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Jeanetta Wark, Jeffry David can be contacted via phone (651) 698-0768.

Contact Information

Primary practice address
1751 County Road B W Ste 100 Roseville MN 55113-4037
Phone: (651) 698-0768
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 09459 Minnesota

Profile Details

NPI number 1982778932
LBN Legal business name Jeanetta Wark, Jeffry David
Credentials MA LICSW
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 20th, 2006
Last updated Mar 21st, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1982778932 NPPES
Other 13GS2WA BCBS
Other 483889 BCBS

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