Basic Information
| Provider Information | |||||||||
| NPI: | 1518294032 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLUEM | ||||||||
| FirstName: | JACQUELINE | ||||||||
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| Credential: | BCC, LADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7580 160TH STREET WEST | ||||||||
| Address2: | |||||||||
| City: | LAKEVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513562938 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7580 160TH STREET WEST | ||||||||
| Address2: | |||||||||
| City: | LAKEVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128710118 | ||||||||
| FaxNumber: | 6128702403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2009 | ||||||||
| LastUpdateDate: | 01/29/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 302710 | MN | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.