Provider Demographics
NPI:1235564238
Name:LONDGREN, JENNIFER KARIN (MS, LMFT, NCC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KARIN
Last Name:LONDGREN
Suffix:
Gender:F
Credentials:MS, LMFT, NCC
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:W175N11120 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6511
Mailing Address - Country:US
Mailing Address - Phone:800-438-1772
Mailing Address - Fax:262-345-5531
Practice Address - Street 1:515 N RIVERFRONT DR
Practice Address - Street 2:SUITE 220
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3471
Practice Address - Country:US
Practice Address - Phone:800-438-1772
Practice Address - Fax:262-345-5531
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN2507101Y00000X, 101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1235564238Medicaid
MN2507OtherLICENSE NUMBER