Provider Demographics
NPI:1760344113
Name:KOENIG, JENNIFER N (TRADITIONAL MIDWIFE)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:KOENIG
Suffix:
Gender:F
Credentials:TRADITIONAL MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13920 YANCY ST NE
Mailing Address - Street 2:
Mailing Address - City:HAM LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55304-7143
Mailing Address - Country:US
Mailing Address - Phone:952-220-3408
Mailing Address - Fax:
Practice Address - Street 1:13920 YANCY ST NE
Practice Address - Street 2:
Practice Address - City:HAM LAKE
Practice Address - State:MN
Practice Address - Zip Code:55304-7143
Practice Address - Country:US
Practice Address - Phone:952-220-3408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay