Provider Demographics
NPI:1104590082
Name:WEISSMAN, JENNIFER (N/A)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WEISSMAN
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29307
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-0307
Mailing Address - Country:US
Mailing Address - Phone:612-508-1604
Mailing Address - Fax:239-228-8640
Practice Address - Street 1:2531 MARSHALL ST NE UNIT A
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-3376
Practice Address - Country:US
Practice Address - Phone:612-508-1604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator