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General NPI Number Information
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NPI Number | 1851601223
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Entity Type | Individual
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Provider Name | JODI P HENNESSEY LICSW
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Gender | Female
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Dates
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Enumeration Date | 10/19/2010
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 5312 RIO BRAVO DR STE 10
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City | SANTA TERESA
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State | NM
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Zip | 88008-9210
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Country | US
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Telephone | 575-915-1338
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Fax |
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Provider Business Mailing Address
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Address Line | 3395 PLYMOUTH RD
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City | MINNETONKA
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State | MN
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Zip | 55422
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Country | US
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Telephone | 952-548-8784
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | SWB-20240206
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License Number State | NM
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