Provider Demographics
NPI:1811633456
Name:SCHMIDT, JENNA MARIE (MS, NCC)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4830 SMITH LAKE RD SE
Mailing Address - Street 2:
Mailing Address - City:OSAKIS
Mailing Address - State:MN
Mailing Address - Zip Code:56360-8061
Mailing Address - Country:US
Mailing Address - Phone:320-808-4190
Mailing Address - Fax:
Practice Address - Street 1:305 30TH AVE W
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-3429
Practice Address - Country:US
Practice Address - Phone:320-460-8028
Practice Address - Fax:320-460-8029
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional