Provider Demographics
NPI:1194821777
Name:YNGSDAHL, JENNIE C (MA, LPP)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:C
Last Name:YNGSDAHL
Suffix:
Gender:F
Credentials:MA, LPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 COUNTY ROAD I
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-6915
Mailing Address - Country:US
Mailing Address - Phone:715-386-0335
Mailing Address - Fax:
Practice Address - Street 1:2431 HENNEPIN AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-2605
Practice Address - Country:US
Practice Address - Phone:612-746-8526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLPP0110103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling