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General NPI Number Information
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NPI Number | 1831664937
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Entity Type | Organization
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Legal Business Name | JENNIE ENSTAD PSY.D.,L.P. PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 10/04/2018
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Last Update Date | 10/04/2018
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Provider Practice Location Address
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Address Line | 2006 1ST AVE STE 101
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City | ANOKA
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State | MN
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Zip | 55303-2255
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Country | US
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Telephone | 763-355-4688
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Fax |
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Provider Business Mailing Address
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Address Line | 17730 GIBBON ST NW
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City | RAMSEY
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State | MN
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Zip | 55303-5510
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Country | US
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Telephone | 763-355-4468
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. JENNIFER ENSTAD
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Credential | PSY.D
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Telephone | 763-355-4468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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