Provider Demographics
NPI:1376818625
Name:KIRCHNER, JOLENE MARIE (MA, RN, LMFT)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:MARIE
Last Name:KIRCHNER
Suffix:
Gender:F
Credentials:MA, RN, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4751 BRISTOL BLVD
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-3989
Mailing Address - Country:US
Mailing Address - Phone:651-442-0928
Mailing Address - Fax:
Practice Address - Street 1:4751 BRISTOL BLVD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-3989
Practice Address - Country:US
Practice Address - Phone:651-442-0928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1175-124106H00000X
MN2915106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist