Individual
MS. JENNIFER JOY KORTGARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
1919 UNIVERSITY AVE W STE 200, SAINT PAUL, MN 55104-3435
(651) 266-7999
(651) 266-7850
Mailing address
2618 N 4TH ST, MINNEAPOLIS, MN 55411-2159
(612) 201-1893
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
21266
MN
1041C0700X
Clinical Social Worker
Primary
21266
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255805800
—
MN
Enumeration date
09/08/2015
Last updated
09/01/2023
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