Provider Demographics
NPI:1548436306
Name:SERSHEN, JEAN KRISTINE (LPC)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:KRISTINE
Last Name:SERSHEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 WINSLOW AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-3331
Mailing Address - Country:US
Mailing Address - Phone:651-224-4430
Mailing Address - Fax:651-241-7168
Practice Address - Street 1:333 SMITH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2344
Practice Address - Country:US
Practice Address - Phone:651-241-8961
Practice Address - Fax:651-241-7168
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00355101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional