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General NPI Number Information
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NPI Number | 1740682798
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Entity Type | Individual
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Provider Name | MS. JESSICA VAN BERKUM
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Gender | Female
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Dates
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Enumeration Date | 09/22/2014
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 4756 BANNING AVE STE 210
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-3206
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Country | US
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Telephone | 612-824-3369
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Fax |
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Provider Business Mailing Address
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Address Line | 1378 TOP LN
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-3620
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Country | US
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Telephone | 612-568-2248
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State | MN
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