Provider Demographics
NPI:1508297359
Name:FOSS, JENNA M (LPCC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:M
Last Name:FOSS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:M
Other - Last Name:KOTLARZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1520 SAVANNA DR
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-5855
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1107 HAZELTINE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1065
Practice Address - Country:US
Practice Address - Phone:952-679-2921
Practice Address - Fax:952-361-0775
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00637101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health