Provider Demographics
NPI:1750842241
Name:KRENTZ, JEREMY TAYLOR (LADC, LICSW)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:TAYLOR
Last Name:KRENTZ
Suffix:
Gender:M
Credentials:LADC, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3701 12TH ST N STE 201
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2253
Mailing Address - Country:US
Mailing Address - Phone:320-229-3760
Mailing Address - Fax:320-229-3764
Practice Address - Street 1:3701 12TH ST N STE 201
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2253
Practice Address - Country:US
Practice Address - Phone:320-229-3760
Practice Address - Fax:320-229-3764
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303541101YA0400X
MN282581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)