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NPI Code Detail

MEDICARE: MRS. JENNIFER KAY PLATH LICSW

MEDICARE: MRS. JENNIFER KAY PLATH LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker18639MN

General Provider Information

NPI Number : 1417243759
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER KAY PLATH LICSW
Provider Business Mailing Address
First Line : 5346 LYNDALE AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55419-1230
Country : US
Telephone Number : 320-583-9597
Fax Number :
Provider Business Practice Location Address
First Line : 5346 LYNDALE AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55419-1230
Country : US
Telephone Number : 320-583-9597
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2011
Last Update Date : 06/24/2011

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