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General NPI Number Information
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NPI Number | 1396707030
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Entity Type | Individual
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Provider Name | JENNIE BEACH MSW LICSW
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Gender | Female
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 18301 HIGHWAY 7
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City | MINNETONKA
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State | MN
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Zip | 55345-4114
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Country | US
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Telephone | 952-248-5344
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Fax |
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Provider Business Mailing Address
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Address Line | 5125 COUNTY ROAD 101
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City | MINNETONKA
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State | MN
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Zip | 55345-4156
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 30424
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License Number State | MN
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