Healthcare Provider Details

I. General information

NPI: 1013129360
Provider Name (Legal Business Name): JENNIFER RUTH ACKLAND MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15930 FINCH AVE
APPLE VALLEY MN
55124-5814
US

IV. Provider business mailing address

15930 FINCH AVE
APPLE VALLEY MN
55124-5814
US

V. Phone/Fax

Practice location:
  • Phone: 952-953-3944
  • Fax:
Mailing address:
  • Phone: 952-953-3944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License NumberH488036272120
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: