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General NPI Number Information
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NPI Number | 1174288302
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Entity Type | Individual
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Provider Name | JENNA DANIELE GUNNERSON PSYD, LP
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Gender | Female
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Dates
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Enumeration Date | 11/02/2021
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 2900 THOMAS AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55416-4477
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Country | US
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Telephone | 612-863-5327
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Fax |
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Provider Business Mailing Address
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Address Line | 4716 KINGSDALE DR
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City | BLOOMINGTON
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State | MN
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Zip | 55437-1829
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Country | US
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Telephone | 612-360-5959
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | LP6745
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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