Provider Demographics
NPI:1538265210
Name:MONSON, JAIME LEA (MSW, LICSW)
Entity type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:LEA
Last Name:MONSON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11324 100TH PL N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-3331
Mailing Address - Country:US
Mailing Address - Phone:763-424-9212
Mailing Address - Fax:
Practice Address - Street 1:5905 GOLDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4463
Practice Address - Country:US
Practice Address - Phone:763-225-4052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN160181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4052401OtherBHP, LICSW
MNHP43545OtherHEALTH PARTNERS, LICSW
MN113370OtherUCARE, LICSW
MN599R8MOOtherBCBS, LICSW