Individual
JACOB PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
2312 S 6TH ST, MINNEAPOLIS, MN 55454-1336
(612) 672-6999
Mailing address
2641 34TH AVE S, MINNEAPOLIS, MN 55406-1735
(319) 415-5464
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
28211
MN
Other
Enumeration date
02/11/2022
Last updated
02/11/2022
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