Provider Demographics
NPI:1649091356
Name:JENNIFER HODGSON CLINICAL SERVICES LLC
Entity type:Organization
Organization Name:JENNIFER HODGSON CLINICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:218-409-8114
Mailing Address - Street 1:61320 W FORK RD
Mailing Address - Street 2:
Mailing Address - City:IRON RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:54847-2600
Mailing Address - Country:US
Mailing Address - Phone:218-409-8114
Mailing Address - Fax:218-234-2993
Practice Address - Street 1:2207 E 5TH ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-3708
Practice Address - Country:US
Practice Address - Phone:218-409-8114
Practice Address - Fax:218-234-2993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty