Provider Demographics
NPI:1780226274
Name:PULKRABEK, JENNA N (LGSW)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:N
Last Name:PULKRABEK
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 19TH PL SE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-9324
Mailing Address - Country:US
Mailing Address - Phone:218-201-0368
Mailing Address - Fax:
Practice Address - Street 1:711 6TH AVE NE # 1
Practice Address - Street 2:
Practice Address - City:ISANTI
Practice Address - State:MN
Practice Address - Zip Code:55040-3207
Practice Address - Country:US
Practice Address - Phone:763-444-5567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN186311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical