Individual provider Active NPI

Jean Kristine Sershen, L.P.C.

  • Professional Counselor
  • Saint Paul, MN
National Provider Identifier
1548436306
Registry record updated Jun 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
00355 Issued in MN
Practice address
333 Smith Ave N
Saint Paul, MN 55102-2344
Phone
(651) 241-8961
Fax
(651) 241-7168
NPI assigned
May 1, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 22, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 00355 MN Primary

Addresses

Primary practice location

333 Smith Ave N
Saint Paul, MN 55102-2344

Mailing address

795 Winslow Ave
Saint Paul, MN 55107-3331
Phone (651) 224-4430

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jsershen33507@excellian.direct.allina.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240117000463 MN Practitioner - Mental Health Counselor 6608226865 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
00355MNMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System CurrentSince Jan 1, 2024 Accepting new patients
Allina Health System CurrentSince Jan 1, 2024 Accepting new patients
Allina Health System Current Accepting new patients

Locations

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

280 Smith Ave N
Ste 450
Saint Paul, MN 55102
Phone (651) 241-5959

333 Smith Ave N
Saint Paul, MN 55102
Phone (651) 220-8256

Interoperability endpoints

  • Direct secure messaging: jsershen33507@excellian.direct.allina.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624320000000",
    "number": "1548436306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "795 WINSLOW AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551073331",
            "telephone_number": "651-224-4430",
            "fax_number": "651-241-7168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 SMITH AVE N",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551022344",
            "telephone_number": "651-241-8961",
            "fax_number": "651-241-7168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SERSHEN",
        "first_name": "JEAN",
        "middle_name": "KRISTINE",
        "name_prefix": "Ms.",
        "credential": "L.P.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-05-01",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "00355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jsershen33507@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "333 Smith Ave N",
            "city": "Saint Paul",
            "state": "MN",
            "country_code": "US",
            "postal_code": "551022344",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.