Provider Demographics
NPI:1043986706
Name:GRESETH, JENNIFER DALSVEEN
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DALSVEEN
Last Name:GRESETH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:DALSVEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1107 HAZELTINE BOULEVARD
Mailing Address - Street 2:SUITE 496, MD 45
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-4301
Mailing Address - Country:US
Mailing Address - Phone:952-240-3334
Mailing Address - Fax:
Practice Address - Street 1:1107 HAZELTINE BOULEVARD
Practice Address - Street 2:SUITE 496, MD 45
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318
Practice Address - Country:US
Practice Address - Phone:952-240-3334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3621106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist