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General NPI Number Information
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NPI Number | 1669365318
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Entity Type | Individual
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Provider Name | JENNA NELSON
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Gender | Female
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 900 CREST VIEW DR STE 220
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City | HUDSON
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State | WI
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Zip | 54016-9517
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Country | US
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Telephone | 715-386-2003
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Fax |
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Provider Business Mailing Address
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Address Line | 6575 184TH ST N
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City | FOREST LAKE
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State | MN
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Zip | 55025-9098
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Country | US
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Telephone | 651-428-9789
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12357-123
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License Number State | WI
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