Provider Demographics
NPI:1891923538
Name:MATTHEWS, JENNIFER YVONNE (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:YVONNE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5511 144TH CT NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-5717
Mailing Address - Country:US
Mailing Address - Phone:651-270-4014
Mailing Address - Fax:
Practice Address - Street 1:5511 144TH CT NW
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-5717
Practice Address - Country:US
Practice Address - Phone:651-270-4014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101Y00000X
MNLPC00780101YP2500X
MN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional