Provider Demographics
NPI:1720572803
Name:NEWLAND, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:NEWLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:BOZOSI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:320 SATURN ST N STE A
Mailing Address - Street 2:
Mailing Address - City:COSMOS
Mailing Address - State:MN
Mailing Address - Zip Code:56228-9757
Mailing Address - Country:US
Mailing Address - Phone:507-339-4933
Mailing Address - Fax:320-877-9088
Practice Address - Street 1:2419 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MONTEVIDEO
Practice Address - State:MN
Practice Address - Zip Code:56265-2619
Practice Address - Country:US
Practice Address - Phone:507-339-4933
Practice Address - Fax:320-877-9088
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1083175442Medicaid