Provider Demographics
NPI:1265559538
Name:COOLIDGE, JENNIFER L (MA, LPCC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:COOLIDGE
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 TRENTON LN N APT 320
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55442-2828
Mailing Address - Country:US
Mailing Address - Phone:651-212-5202
Mailing Address - Fax:844-231-8867
Practice Address - Street 1:12099 LINDSTROM LN
Practice Address - Street 2:
Practice Address - City:LINDSTROM
Practice Address - State:MN
Practice Address - Zip Code:55045-9543
Practice Address - Country:US
Practice Address - Phone:651-212-5202
Practice Address - Fax:844-231-8867
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN83101YM0800X
MN0083101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE