Provider Demographics
NPI:1619222478
Name:WILLS, JENNIFER K (CMT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:WILLS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:K
Other - Last Name:KLOFSTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMT
Mailing Address - Street 1:131 BROADWAY AVE S
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56329-8531
Mailing Address - Country:US
Mailing Address - Phone:320-493-9984
Mailing Address - Fax:
Practice Address - Street 1:401 DEWEY ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:MN
Practice Address - Zip Code:56329-8406
Practice Address - Country:US
Practice Address - Phone:320-968-7413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist