Provider Demographics
NPI:1922611540
Name:ROLL, JENNIFER E
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:E
Last Name:ROLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:NONE
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:700 COMMERCE DR STE 260
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-9243
Mailing Address - Country:US
Mailing Address - Phone:651-328-6286
Mailing Address - Fax:651-328-6281
Practice Address - Street 1:700 COMMERCE DR STE 260
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-9243
Practice Address - Country:US
Practice Address - Phone:651-328-6286
Practice Address - Fax:651-328-6281
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician