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General NPI Number Information
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NPI Number | 1497877740
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Entity Type | Individual
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Provider Name | JENNIFER FRANCES WISEMAN MSW, LICSW
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Gender | Female
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 13100 WAYZATA BLVD OFC CTR
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City | MINNETONKA
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State | MN
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Zip | 55305-1802
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Country | US
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Telephone | 952-206-2040
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Fax |
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Provider Business Mailing Address
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Address Line | 5301 MICHAELE LN
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City | MINNETONKA
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State | MN
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Zip | 55345-4225
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Country | US
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Telephone | 651-788-3945
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 12336
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License Number State | MN
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