Basic Information
| Provider Information | |||||||||
| NPI: | 1780074997 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHRISTMAS | ||||||||
| FirstName: | JAIME | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1221 W LAKE ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554083397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128241772 | ||||||||
| FaxNumber: | 6128214799 | ||||||||
| Practice Location | |||||||||
| Address1: | 1221 W LAKE ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554083397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128241772 | ||||||||
| FaxNumber: | 6128214799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2015 | ||||||||
| LastUpdateDate: | 01/26/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 19864 | MN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.