Provider Demographics
NPI:1902590136
Name:KROESE, JASMINE (MA)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:KROESE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 HEWITT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1129
Mailing Address - Country:US
Mailing Address - Phone:925-885-9221
Mailing Address - Fax:
Practice Address - Street 1:333 GRAND AVE STE 205
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2583
Practice Address - Country:US
Practice Address - Phone:651-294-2307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health