Provider Demographics
NPI:1043910383
Name:JARRETT, ELENA
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:JARRETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 KRUCHTEN CT S
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4645
Mailing Address - Country:US
Mailing Address - Phone:320-940-7660
Mailing Address - Fax:
Practice Address - Street 1:1908 KRUCHTEN CT S
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4645
Practice Address - Country:US
Practice Address - Phone:320-940-7660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician