Organization
CENTER FOR INTEGRATED WELL BEING INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFRY DAVID JEANETTA WARK MA LICSW (OWNER)
(651) 698-0768
Entity
Organization
Contact information
Practice address
1449 GRAND AVE, SAINT PAUL, MN 55105-2206
(651) 698-0768
(651) 698-0660
Mailing address
1449 GRAND AVE, SAINT PAUL, MN 55105-2206
(651) 698-0768
(651) 698-0660
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13GS2WA
BCBS
—
01
—
483889
VALUE OPTIONS
—
Enumeration date
11/20/2006
Last updated
08/22/2020
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