Individual
MS. JEAN EMILY BALESTRERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW, MAC, ACSW
Contact information
Practice address
348 PRIOR AVE N, SAINT PAUL, MN 55104-5187
(952) 250-5531
Mailing address
3153 GEORGIA AVE S, ST LOUIS PARK, MN 55426-3430
(952) 250-5531
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
17225
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
039128000
—
MN
Enumeration date
06/18/2006
Last updated
07/08/2007
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