Individual
JEANETTE L ZACZKOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW LICSW
Contact information
Practice address
1811 WEIR DRIVE, SUITE 355 MAIL STOP 13701A, WOODBURY, MN 55125-2273
(651) 730-6151
(651) 730-1700
Mailing address
8100 34TH AVE S, 21110Q, BLOOMINGTON, MN 55425-1672
(952) 883-7961
(952) 883-5395
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
13080
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
924609600
—
MN
Enumeration date
02/21/2006
Last updated
11/04/2014
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