Provider Demographics
NPI:1477252955
Name:KELLEY, JENNIFER BLANCA (MS, IN MFT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:BLANCA
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MS, IN MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 633
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:MN
Mailing Address - Zip Code:56320-0633
Mailing Address - Country:US
Mailing Address - Phone:320-260-6772
Mailing Address - Fax:855-291-6387
Practice Address - Street 1:1144 29TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5632
Practice Address - Country:US
Practice Address - Phone:320-260-6772
Practice Address - Fax:855-291-6387
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7569867OtherOUT OF NETWORK POLICY AND MOST CREDIT CARDS ARE ACCEPTED