Healthcare Provider Details

I. General information

NPI: 1730076811
Provider Name (Legal Business Name): JOCELYN THOEMKE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2637 27TH AVE S STE 240
MINNEAPOLIS MN
55406-3197
US

IV. Provider business mailing address

1795 TATUM ST
SAINT PAUL MN
55113-5525
US

V. Phone/Fax

Practice location:
  • Phone: 612-758-0155
  • Fax: 612-416-8167
Mailing address:
  • Phone: 651-214-0715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOCELYN ROSE THOEMKE
Title or Position: OWNER
Credential: LMFT
Phone: 651-214-0715