Healthcare Provider Details

I. General information

NPI: 1770414831
Provider Name (Legal Business Name): JENNIFER HARRISON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FREEMAN DR
SAINT PETER MN
56082-3504
US

IV. Provider business mailing address

100 FREEMAN DR
SAINT PETER MN
56082-3504
US

V. Phone/Fax

Practice location:
  • Phone: 507-469-3683
  • Fax: 651-431-7778
Mailing address:
  • Phone: 507-469-3683
  • Fax: 651-431-7778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberLP6257
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: