Healthcare Provider Details

I. General information

NPI: 1588088405
Provider Name (Legal Business Name): JEFFREY BREER M.S.W., L.I.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 130TH AVE S
ONAMIA MN
56359-3115
US

IV. Provider business mailing address

104 CROSIER DR
ONAMIA MN
56359-4512
US

V. Phone/Fax

Practice location:
  • Phone: 320-532-4005
  • Fax: 320-532-4898
Mailing address:
  • Phone: 320-532-3103
  • Fax: 320-532-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11229
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: