Healthcare Provider Details

I. General information

NPI: 1093845679
Provider Name (Legal Business Name): JACQUELINE SUZANNE DENISON GETCHIUS B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 EXCELSIOR BLVD STE 365
MINNEAPOLIS MN
55416-4688
US

IV. Provider business mailing address

8688 SHILOH CT
EDEN PRAIRIE MN
55347-1727
US

V. Phone/Fax

Practice location:
  • Phone: 612-743-6471
  • Fax:
Mailing address:
  • Phone: 612-743-6471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1163
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: