Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Jeffry David Jeanetta Wark, MALICSW

Individual provider Clinical Social Worker · NPI 1982778932

Mr. Jeffry David Jeanetta Wark, MALICSW is a Clinical Social Worker in Roseville, Minnesota. Qualified in 1991, 35 years ago. Practices as a sole proprietor and offers telehealth. Licensed in Minnesota.

Years since qualifying
35
Licensed in
MN
In the registry since
2006
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Practice location Address checks out

1751 County Road B W Ste 100
Roseville, MN 55113-4037
Phone: (651) 698-0768
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 09459 (MN)

Record details

NPI number1982778932
Entity typeIndividual (Type 1)
GenderMale
Credentials MALICSW
Sole proprietorYes
NPI enumeratedNovember 20, 2006
Last updated in NPPESMarch 21, 2018

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 1991 (35 years in practice)
Accepts Medicare assignment Not indicated
TelehealthOffers telehealth services

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