Provider Demographics
NPI:1265704506
Name:PRITCHARD, JODI RENEE (LICSW)
Entity type:Individual
Prefix:MS
First Name:JODI
Middle Name:RENEE
Last Name:PRITCHARD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S 6TH ST
Mailing Address - Street 2:A-16
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55487-0999
Mailing Address - Country:US
Mailing Address - Phone:612-348-5338
Mailing Address - Fax:612-466-9684
Practice Address - Street 1:300 S 6TH ST
Practice Address - Street 2:A-16
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55487-0999
Practice Address - Country:US
Practice Address - Phone:612-348-5338
Practice Address - Fax:612-466-9684
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical