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General NPI Number Information
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NPI Number | 1689569675
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Entity Type | Individual
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Provider Name | JENNIFER SUSAN HAYES LADC
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Gender | Female
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Dates
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Enumeration Date | 06/10/2025
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 3705 PARK CENTER BLVD
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-2504
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Country | US
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Telephone | 952-405-7644
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Fax |
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Provider Business Mailing Address
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Address Line | 8026 MAGNOLIA LN N
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City | MAPLE GROVE
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State | MN
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Zip | 55369-7177
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Country | US
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Telephone | 612-559-7160
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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