Provider Demographics
NPI:1508075573
Name:JENNINGS, LENNY LAWRENCE (PHD, LP)
Entity Type:Individual
Prefix:
First Name:LENNY
Middle Name:LAWRENCE
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 W 44TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1032
Mailing Address - Country:US
Mailing Address - Phone:952-922-1977
Mailing Address - Fax:952-922-1980
Practice Address - Street 1:3919 W 44TH ST STE 200
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1032
Practice Address - Country:US
Practice Address - Phone:952-922-1977
Practice Address - Fax:952-922-1980
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMNLP3388103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling