Organization
REVIVE WELLNESS
Active
Other names
Jessica Shockman
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JESSICA NICHOLE SHOCKMAN LICSW (MENTAL HEALTH PROFESSIONAL)
(218) 289-7023
Entity
Organization
Contact information
Practice address
116 W ROBERT ST STE 2B, CROOKSTON, MN 56716-1709
(218) 289-7023
Mailing address
116 W ROBERT ST STE 2B, CROOKSTON, MN 56716-1709
(218) 289-7023
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
01/27/2023
Last updated
01/27/2023
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