1154464477 NPI number — JENNIFER AESHLIMAN LICSW

Table of content: JENNIFER AESHLIMAN LICSW (NPI 1154464477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154464477 NPI number — JENNIFER AESHLIMAN LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AESHLIMAN
Provider First Name:
JENNIFER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154464477
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8990 SPRINGBROOK DR NW
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
COON RAPIDS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55433-5850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-780-4440
Provider Business Mailing Address Fax Number:
763-780-9219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8990 SPRINGBROOK DR NW
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
COON RAPIDS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55433-5850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-780-4440
Provider Business Practice Location Address Fax Number:
763-780-9219
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  15271 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 610K9AE . This is a "BLUE CROSS OF MINNESOTA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com