Healthcare Provider Details

I. General information

NPI: 1558766998
Provider Name (Legal Business Name): JESSICA SAWYER M.A., L.M.F.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 LONG LAKE RD STE 160
NEW BRIGHTON MN
55112-6414
US

IV. Provider business mailing address

79 13TH AVE NE 103B
MINNEAPOLIS MN
55413-1070
US

V. Phone/Fax

Practice location:
  • Phone: 612-706-9630
  • Fax: 612-706-9617
Mailing address:
  • Phone: 612-234-7266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1996
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: