Provider Demographics
NPI:1316649775
Name:POGREBA, JENNIE JEAN (LICSW)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:JEAN
Last Name:POGREBA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 DEERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55388-9275
Mailing Address - Country:US
Mailing Address - Phone:952-807-8059
Mailing Address - Fax:
Practice Address - Street 1:4154 SHORELINE DR
Practice Address - Street 2:
Practice Address - City:SPRING PARK
Practice Address - State:MN
Practice Address - Zip Code:55384-5606
Practice Address - Country:US
Practice Address - Phone:612-567-0316
Practice Address - Fax:952-491-9460
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN147161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical