Provider Demographics
NPI:1194105205
Name:WHITEMAN, JAMIE TERESA (MSW, LGSW)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:TERESA
Last Name:WHITEMAN
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2506
Mailing Address - Street 2:7251 EXCELSIOR RD
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-2506
Mailing Address - Country:US
Mailing Address - Phone:218-454-0878
Mailing Address - Fax:218-454-0879
Practice Address - Street 1:7251 EXCELSIOR RD
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8477
Practice Address - Country:US
Practice Address - Phone:218-454-0878
Practice Address - Fax:218-454-0879
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24075104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker