MEDICARE: JENNIFER PAIGE LPCC, LADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	CC01584	MN

General Provider Information

NPI Number	:	1235628710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER PAIGE LPCC, LADC

Provider Business Mailing Address
First Line	:	310 E 38TH ST STE 322
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55409-1300
Country	:	US
Telephone Number	:	612-824-0415
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 E 38TH ST STE 322
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55409-1300
Country	:	US
Telephone Number	:	612-824-0415
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2018
Last Update Date	:	12/12/2025

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