Provider Demographics
NPI:1790033371
Name:DOEDEN, JENNIFER MARIE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:DOEDEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:RYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:9201 QUADAY AVE NE STE 205
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55330-6604
Mailing Address - Country:US
Mailing Address - Phone:763-309-1005
Mailing Address - Fax:651-222-9727
Practice Address - Street 1:9201 QUADAY AVE NE STE 205
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-6604
Practice Address - Country:US
Practice Address - Phone:763-309-1005
Practice Address - Fax:651-222-9727
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2495106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist