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NPI Code Detail

MEDICARE: JENNIFER CATHERINE POWERS MSW, LICSW

MEDICARE: JENNIFER CATHERINE POWERS MSW, 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 Worker14779MN

General Provider Information

NPI Number : 1861790321
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER CATHERINE POWERS MSW, LICSW
Provider Business Mailing Address
First Line : 2925 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1321
Country : US
Telephone Number : 612-262-9000
Fax Number :
Provider Business Practice Location Address
First Line : 17489 DODD BLVD
Second Line :
City : LAKEVILLE
State : MN
Zip : 55044-6506
Country : US
Telephone Number : 952-428-1020
Fax Number : 952-428-1025
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2011
Last Update Date : 01/30/2025

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