Provider Demographics
NPI:1174736532
Name:JASPERSEN, FAITH MARIE (LICSW)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:MARIE
Last Name:JASPERSEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-2552
Mailing Address - Country:US
Mailing Address - Phone:651-699-5930
Mailing Address - Fax:612-379-5328
Practice Address - Street 1:1089 10TH AVE SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-1312
Practice Address - Country:US
Practice Address - Phone:612-746-8172
Practice Address - Fax:612-379-5328
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical