Healthcare Provider Details

I. General information

NPI: 1437974821
Provider Name (Legal Business Name): JENIFER LYNN KUHFUSS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENIFER LYNN KANIS

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6120 EARLE BROWN DR STE 100
BROOKLYN CENTER MN
55430-4100
US

IV. Provider business mailing address

6120 EARLE BROWN DR STE 100
BROOKLYN CENTER MN
55430-4100
US

V. Phone/Fax

Practice location:
  • Phone: 763-277-1020
  • Fax: 763-537-7162
Mailing address:
  • Phone: 763-277-1020
  • Fax: 763-537-7162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22997
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: