Provider Demographics
NPI:1740970342
Name:LANDRY, JENNIFER (LGSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LANDRY
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BARTON AVE SE APT 1
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3541
Mailing Address - Country:US
Mailing Address - Phone:608-219-5244
Mailing Address - Fax:
Practice Address - Street 1:3459 WASHINGTON DR STE 102
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1388
Practice Address - Country:US
Practice Address - Phone:608-219-5244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker