Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | LP4639 | MN |
NPI | 1093725467 |
---|---|
Provider Name | Dr. Jennifer G Enstad |
First Address | Ramsey, MN 55303-5510 |
Second Address | Maple Grove, MN 55369-5202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 08/07/2007 |