Provider Demographics
NPI:1497371504
Name:SOUKUP, JENNA DEANE (MS, CGC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:DEANE
Last Name:SOUKUP
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ROBERT ST N
Mailing Address - Street 2:PO BOX 64899
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55164
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 ROBERT ST N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55155-2531
Practice Address - Country:US
Practice Address - Phone:651-201-3563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS