Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | LP5159 | MN |
Y | 103TC0700X | Clinical Psychologist | LP5159 | MN |
NPI | 1003141979 |
---|---|
Provider Name | Dr. Jennifer Rene Gozy |
First Address | Minneapolis, MN 55404-3461 |
Second Address | Minneapolis, MN 55404-3461 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2009 |
Last Update Date | 07/12/2009 |