MEDICARE: FAITH JAEGER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	1582	MN

General Provider Information

NPI Number	:	1326424847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAITH JAEGER

Provider Business Mailing Address
First Line	:	2955 E RUM RIVER DR S
Second Line	:
City	:	CAMBRIDGE
State	:	MN
Zip	:	55008-2680
Country	:	US
Telephone Number	:	763-639-9774
Fax Number	:

Provider Business Practice Location Address
First Line	:	7084 E FISH LAKE RD
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-2832
Country	:	US
Telephone Number	:	763-639-9774
Fax Number	:	763-225-4466

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2015
Last Update Date	:	09/02/2021

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