Provider Demographics
NPI:1669816179
Name:KRZEWINA, JENNIFER M (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:KRZEWINA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7236 FORESTVIEW LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-5656
Mailing Address - Country:US
Mailing Address - Phone:612-599-5197
Mailing Address - Fax:763-657-1735
Practice Address - Street 1:7236 FORESTVIEW LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-5656
Practice Address - Country:US
Practice Address - Phone:612-599-5197
Practice Address - Fax:763-657-1735
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1184920753Medicaid