Provider Demographics
NPI:1760677942
Name:PEARSON, JENNIFER (LMFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6636 CEDAR AVE S STE 308
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2707
Mailing Address - Country:US
Mailing Address - Phone:612-223-6780
Mailing Address - Fax:612-243-3615
Practice Address - Street 1:6636 CEDAR AVE S STE 380
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2712
Practice Address - Country:US
Practice Address - Phone:612-798-7373
Practice Address - Fax:612-243-3615
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0964106H00000X
MN964106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist