Healthcare Provider Details

I. General information

NPI: 1194821777
Provider Name (Legal Business Name): JENNIE C. YNGSDAHL MA, LPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2431 HENNEPIN AVE
MINNEAPOLIS MN
55405-2605
US

IV. Provider business mailing address

1137 COUNTY ROAD I
HUDSON WI
54016-6915
US

V. Phone/Fax

Practice location:
  • Phone: 612-746-8526
  • Fax:
Mailing address:
  • Phone: 715-386-0335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLPP0110
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: