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General NPI Number Information
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NPI Number | 1205764065
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Entity Type | Individual
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Provider Name | JENNA MCKENZIE
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Gender | Female
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Dates
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Enumeration Date | 05/12/2026
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Last Update Date | 05/12/2026
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Provider Practice Location Address
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Address Line | 1155 NORTHLAND DR
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City | MENDOTA HEIGHTS
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State | MN
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Zip | 55120-1288
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Country | US
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Telephone | 763-330-9225
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Fax | 833-972-1118
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Provider Business Mailing Address
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Address Line | 1155 NORTHLAND DR
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City | MENDOTA HEIGHTS
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State | MN
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Zip | 55120-1288
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Country | US
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Telephone | 763-330-9225
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Fax | 833-972-1118
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1174477350
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1164121976
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1972084226
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1962955302
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License Number State | MN
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1962152827
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License Number State | MN
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Taxonomy #6
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1194195248
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License Number State | MN
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