Healthcare Provider Details

I. General information

NPI: 1124519996
Provider Name (Legal Business Name): JENNIFER LEE CHRISTY MS, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENN CHRISTY MS, MT-BC

II. Dates (important events)

Enumeration Date: 05/28/2018
Last Update Date: 05/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 VIRGINIA AVE S APT 302
ST LOUIS PARK MN
55426-3669
US

IV. Provider business mailing address

3100 VIRGINIA AVE S APT 302
ST LOUIS PARK MN
55426-3669
US

V. Phone/Fax

Practice location:
  • Phone: 208-484-1748
  • Fax:
Mailing address:
  • Phone: 208-484-1748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: