Individual
JERALD JEROME NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
2925 20TH ST S, MOORHEAD, MN 56560-5269
(701) 318-4292
Mailing address
13299 WILDFLOWER LN, LAKE PARK, MN 56554-9132
(701) 318-4292
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
07373
MN
Other
Enumeration date
04/16/2007
Last updated
07/08/2007
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