Individual
JESSICA BIBEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
287 6TH ST E, SAINT PAUL, MN 55101-1654
(651) 221-0334
Mailing address
287 6TH ST E, SAINT PAUL, MN 55101-1654
(651) 221-0334
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
303784
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
303784
—
MN
Enumeration date
12/12/2016
Last updated
12/12/2016
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