Provider Demographics
NPI:1013979848
Name:SIMS, JODI LYNN (MA LMFT)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LYNN
Last Name:SIMS
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:LYNN
Other - Last Name:MARCINIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14115 JAMES RD STE 305
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-9417
Mailing Address - Country:US
Mailing Address - Phone:763-575-8086
Mailing Address - Fax:320-774-0415
Practice Address - Street 1:14115 JAMES RD STE 305
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-9417
Practice Address - Country:US
Practice Address - Phone:763-575-8086
Practice Address - Fax:320-774-0415
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN996106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
172690OtherU CARE
MN1028944OtherPREFERRED ONE
MN229R3S1OtherBCBS
MN1043012OtherPREFERRED ONE
HP40189OtherHEALTH PARTNERS
6260869OtherUBH
MN914617200Medicaid