Healthcare Provider Details

I. General information

NPI: 1194479212
Provider Name (Legal Business Name): JACYNTE R DENARDO LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9325 UPLAND LN N STE 210
MAPLE GROVE MN
55369-5777
US

IV. Provider business mailing address

9325 UPLAND LN N STE 210
MAPLE GROVE MN
55369-5777
US

V. Phone/Fax

Practice location:
  • Phone: 612-915-0049
  • Fax: 651-925-0041
Mailing address:
  • Phone: 612-915-0049
  • Fax: 651-925-0041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4639
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: