MEDICARE: MS. JENNIFER LEIGH POHL L.P.

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	103TC0700X	Clinical Psychologist	LP4777	MN

General Provider Information

NPI Number	:	1639375421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER LEIGH POHL L.P.

Provider Business Mailing Address
First Line	:	310 E 38TH ST
Second Line	:	SUITE 120
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55409-1300
Country	:	US
Telephone Number	:	612-238-2395
Fax Number	:	612-813-0786

Provider Business Practice Location Address
First Line	:	310 E 38TH ST
Second Line	:	SUITE 120
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55409-1300
Country	:	US
Telephone Number	:	612-238-2395
Fax Number	:	612-813-0786

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

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	07/08/2007

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