Provider Demographics
NPI:1154754984
Name:RIVARD, JEAN (LICSW)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:RIVARD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:HAMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:621 W LAKE ST
Mailing Address - Street 2:STE 350
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2952
Mailing Address - Country:US
Mailing Address - Phone:612-979-2276
Mailing Address - Fax:651-925-0427
Practice Address - Street 1:332 W SUPERIOR ST
Practice Address - Street 2:SUITE 300
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1808
Practice Address - Country:US
Practice Address - Phone:218-722-4379
Practice Address - Fax:218-722-4333
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical