Provider Demographics
NPI:1447273925
Name:TRUER, JEROME WESLEY (MA, LICSW)
Entity type:Individual
Prefix:MR
First Name:JEROME
Middle Name:WESLEY
Last Name:TRUER
Suffix:
Gender:M
Credentials:MA, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 HOLMES AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2628
Mailing Address - Country:US
Mailing Address - Phone:612-824-9745
Mailing Address - Fax:612-827-8916
Practice Address - Street 1:3009 HOLMES AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2628
Practice Address - Country:US
Practice Address - Phone:612-824-9745
Practice Address - Fax:612-827-8916
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN72951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical