Individual
MRS. JENNIFER LANE GERVAIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
7616 CURRELL BLVD, SUITE 275, WOODBURY, MN 55125-2290
(612) 859-9405
Mailing address
7616 CURRELL BLVD, SUITE 275, WOODBURY, MN 55125-2290
(612) 859-9405
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
15252
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
136608400
CADI
—
05
—
136608400
—
MN
Enumeration date
04/06/2006
Last updated
09/18/2008
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