Healthcare Provider Details

I. General information

NPI: 1235628710
Provider Name (Legal Business Name): JENNIFER PAIGE LPCC, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E 38TH ST STE 322
MINNEAPOLIS MN
55409-1300
US

IV. Provider business mailing address

310 E 38TH ST STE 322
MINNEAPOLIS MN
55409-1300
US

V. Phone/Fax

Practice location:
  • Phone: 612-824-0415
  • Fax:
Mailing address:
  • Phone: 612-824-0415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC01584
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: