Healthcare Provider Details

I. General information

NPI: 1235848425
Provider Name (Legal Business Name): DR JENNA THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2136 FORD PKWY # 8240
SAINT PAUL MN
55116-2850
US

IV. Provider business mailing address

2136 FORD PKWY # 8240
SAINT PAUL MN
55116-2850
US

V. Phone/Fax

Practice location:
  • Phone: 612-208-6623
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNA BROWNFIELD
Title or Position: OWNER/PSYCHOLOGIST
Credential:
Phone: 612-208-6623