Individual
JANE PAULINE KOMAREK-PAVKOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW LADC
Contact information
Practice address
1406 6TH AVENUE NORTH, ST CLOUD HOSPITAL, ST CLOUD, MN 56303-1901
(320) 251-2700
(320) 229-3765
Mailing address
1406 6TH AVE N, ST CLOUD HOSPITAL, ST CLOUD, MN 56303-1901
(320) 251-2700
(320) 229-3765
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
301224
MN
1041C0700X
Clinical Social Worker
Primary
12130
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
510037200
—
MN
Enumeration date
05/09/2006
Last updated
10/04/2017
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