MEDICARE: JENNA HALVORSON LPCC

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
1	101YP2500X	Professional Counselor	CC03692	MN
2	101YM0800X	Mental Health Counselor	CC03692	MN
3	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1811394794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA HALVORSON LPCC

Provider Business Mailing Address
First Line	:	84 WATER ST W APT 719
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55107-4405
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2855 ANTHONY LN S STE 201
Second Line	:
City	:	ST ANTHONY
State	:	MN
Zip	:	55418-2637
Country	:	US
Telephone Number	:	651-217-1480
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2014
Last Update Date	:	02/06/2026

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