Provider Demographics
NPI:1558988956
Name:DASHOW, JENNIFER ELLEN (BS, LADC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELLEN
Last Name:DASHOW
Suffix:
Gender:F
Credentials:BS, LADC
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:ELLEN
Other - Last Name:DASHOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS, LADC
Mailing Address - Street 1:5024 LILAC DR N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3412
Mailing Address - Country:US
Mailing Address - Phone:612-750-0795
Mailing Address - Fax:
Practice Address - Street 1:1101 E 78TH ST STE 100
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-1402
Practice Address - Country:US
Practice Address - Phone:952-234-8604
Practice Address - Fax:952-854-5363
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305567101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)