Healthcare Provider Details

I. General information

NPI: 1114170099
Provider Name (Legal Business Name): JANET AGNES HUTTON SENJEM M.S.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 1ST AVE NE STE 217
ROCHESTER MN
55906-4170
US

IV. Provider business mailing address

1500 1ST.AVE.N.E. SUITE 217
ROCHESTER MN
55906
US

V. Phone/Fax

Practice location:
  • Phone: 507-281-5928
  • Fax:
Mailing address:
  • Phone: 507-281-5928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06700
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: