Healthcare Provider Details

I. General information

NPI: 1427131713
Provider Name (Legal Business Name): JENIFER ELIZABETH JOHN MA LMFT LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 BROADWAY ST E
MONTICELLO MN
55362
US

IV. Provider business mailing address

261 E BROADWAY ST PO BOX 1342
MONTICELLO MN
55362-9317
US

V. Phone/Fax

Practice location:
  • Phone: 763-262-3077
  • Fax: 763-262-1113
Mailing address:
  • Phone: 763-232-7403
  • Fax: 763-262-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07448
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0875
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: