Healthcare Provider Details

I. General information

NPI: 1942146360
Provider Name (Legal Business Name): JENNIFER JAYLEE SEYAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10020 PLEASURE CREEK PKWY E
BLAINE MN
55434-4212
US

IV. Provider business mailing address

222 AUBURN ST STE 103
PORTLAND ME
04103-6005
US

V. Phone/Fax

Practice location:
  • Phone: 763-291-3780
  • Fax:
Mailing address:
  • Phone: 207-616-1127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number35621
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: