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General NPI Number Information
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NPI Number | 1780214601
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Entity Type | Individual
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Provider Name | JENNIFER JACQUELINE FELINSKI KURTZ-PORT PSYD
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Gender | Female
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Dates
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Enumeration Date | 01/20/2020
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 20397 GREENGATE CT
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City | LAKEVILLE
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State | MN
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Zip | 55044-4877
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Country | US
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Telephone | 612-247-3314
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Fax | 952-898-1976
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Provider Business Mailing Address
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Address Line | 20397 GREENGATE CT
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City | LAKEVILLE
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State | MN
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Zip | 55044-4877
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Country | US
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Telephone | 612-247-3314
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Fax | 952-898-1976
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP4792
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | LP4792
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License Number State | MN
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