MEDICARE: DR. JENNIFER LYNN JOSEPH PSY.D., LP

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	103TB0200X	Cognitive & Behavioral Psychologist	4669	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	637K9SH	OTHER	MN	BCBS
2	HP66846	OTHER	MN	HEALTH PARTNERS

General Provider Information

NPI Number	:	1417035551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER LYNN JOSEPH PSY.D., LP

Provider Business Mailing Address
First Line	:	5762 213TH ST N
Second Line	:
City	:	FOREST LAKE
State	:	MN
Zip	:	55025-9589
Country	:	US
Telephone Number	:	651-982-4903
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 BROADWAY ST NE
Second Line	:	SUITE 185
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-2195
Country	:	US
Telephone Number	:	612-767-4224
Fax Number	:

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/08/2007

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