Provider Demographics
NPI:1437828407
Name:PATEL, JENNA (BS MHP)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:BS MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 YORK AVE S APT 912
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4446
Mailing Address - Country:US
Mailing Address - Phone:817-891-6787
Mailing Address - Fax:
Practice Address - Street 1:7201 YORK AVE S APT 912
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4446
Practice Address - Country:US
Practice Address - Phone:817-891-6787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-12
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician