Provider Demographics
NPI:1710241096
Name:FRIESEN, JENNIFER M (CMT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:M
Last Name:FRIESEN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 MARSCHALL RD
Mailing Address - Street 2:#205 A
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-1686
Mailing Address - Country:US
Mailing Address - Phone:952-465-9626
Mailing Address - Fax:
Practice Address - Street 1:287 MARSCHALL RD
Practice Address - Street 2:#205 A
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-1686
Practice Address - Country:US
Practice Address - Phone:952-465-9626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-01
Last Update Date:2012-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist