Provider Demographics
NPI:1679752067
Name:JENNINGS, KARRIE ANN (MA, LMFT, CEAP)
Entity Type:Individual
Prefix:MRS
First Name:KARRIE
Middle Name:ANN
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MA, LMFT, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23175 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-8264
Mailing Address - Country:US
Mailing Address - Phone:952-469-4159
Mailing Address - Fax:
Practice Address - Street 1:23175 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-8264
Practice Address - Country:US
Practice Address - Phone:952-469-4159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0911106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist