Niemand, Jackie Sue

Niemand, Jackie Sue is an sole proprietor health care provider with primary practice located at 6381 Osgood Ave N Ste 8 , Stillwater MN 55082-6182. She recently has 5 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical Child & Adolescent, Behavioral Health & Social Service Providers / Family, Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / Cognitive & Behavioral, Behavioral Health & Social Service Providers / Counseling. Behavioral Health & Social Service Providers / Psychologist is her primary health care specialty. Niemand, Jackie Sue can be contacted via phone (651) 275-9680.

Contact Information

Primary practice address
6381 Osgood Ave N Ste 8 Stillwater MN 55082-6182
Phone: (651) 275-9680
Fax: (651) 430-9296
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X LP3518 Minnesota
Behavioral Health & Social Service Providers / Family 103TF0000X LP3518 Minnesota
Behavioral Health & Social Service Providers / Psychologist 103T00000X LP3518 Minnesota
Behavioral Health & Social Service Providers / Cognitive & Behavioral 103TB0200X LP3518 Minnesota
Behavioral Health & Social Service Providers / Counseling 103TC1900X LP3518 Minnesota

Profile Details

NPI number 1417958893
LBN Legal business name Niemand, Jackie Sue
Credentials LIC PSYCHOLOGIST
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 9th, 2005
Last updated Feb 10th, 2021 - about 4 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 1417958893 NPPES
Minnesota Other 56B45NI BLUE CROSS BLUE SHIELD MN
Minnesota Other 6236625 BLUE CROSS BLUE SHIELD MN
Minnesota MEDICAID 154015700 BLUE CROSS BLUE SHIELD MN

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