Individual
JACOB RUSSELL ROOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
902 E 2ND ST STE 224, WINONA, MN 55987-6509
(651) 272-9562
Mailing address
902 E 2ND ST STE 224, WINONA, MN 55987-6509
(651) 272-9562
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
3588
MN
106H00000X
Marriage & Family Therapist
Primary
LF60918068
WA
Other
Enumeration date
07/16/2018
Last updated
06/03/2021
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