Provider Demographics
NPI:1275864019
Name:JENNIGES, LINDSAY (LICSW)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:JENNIGES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 CLARY ST
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-2005
Mailing Address - Country:US
Mailing Address - Phone:507-376-6121
Mailing Address - Fax:507-372-4304
Practice Address - Street 1:1211 CLARY ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-2005
Practice Address - Country:US
Practice Address - Phone:507-376-6121
Practice Address - Fax:507-372-4304
Is Sole Proprietor?:No
Enumeration Date:2010-01-19
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN180791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical