Healthcare Provider Details

I. General information

NPI: 1427708650
Provider Name (Legal Business Name): JENNA A RUFF BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 US-169 SUITE 100
NEW HOPE MN
55428
US

IV. Provider business mailing address

4900 US-169 SUITE 100
NEW HOPE MN
55428
US

V. Phone/Fax

Practice location:
  • Phone: 612-877-8800
  • Fax:
Mailing address:
  • Phone: 612-877-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number108000
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: