Provider Demographics
NPI:1326279001
Name:RAHN, JILL SUZANNE (LIC ACU)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:SUZANNE
Last Name:RAHN
Suffix:
Gender:F
Credentials:LIC ACU
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:SUZANNE
Other - Last Name:NEUKAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10631 NATHAN LANE N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-2634
Mailing Address - Country:US
Mailing Address - Phone:612-229-0322
Mailing Address - Fax:763-210-5417
Practice Address - Street 1:480 OSBORNE RD NE STE 200
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2866
Practice Address - Country:US
Practice Address - Phone:763-236-5601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1303171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist