Provider Demographics
NPI:1265825939
Name:JENNISSEN, BRIANN RAE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:BRIANN
Middle Name:RAE
Last Name:JENNISSEN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1133 RANKIN ST
Mailing Address - Street 2:SUITE 221
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-3141
Mailing Address - Country:US
Mailing Address - Phone:651-222-7768
Mailing Address - Fax:651-698-8994
Practice Address - Street 1:14050 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337
Practice Address - Country:US
Practice Address - Phone:952-993-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9402235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist