Healthcare Provider Details

I. General information

NPI: 1326424847
Provider Name (Legal Business Name): FAITH JAEGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7084 E FISH LAKE RD
MAPLE GROVE MN
55311-2832
US

IV. Provider business mailing address

2955 E RUM RIVER DR S
CAMBRIDGE MN
55008-2680
US

V. Phone/Fax

Practice location:
  • Phone: 763-639-9774
  • Fax: 763-225-4466
Mailing address:
  • Phone: 763-639-9774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1582
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: