Provider Demographics
NPI:1982978656
Name:YOUNGS, JENNIFER MARRION (CMT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARRION
Last Name:YOUNGS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37686 ELEANOR AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-5546
Mailing Address - Country:US
Mailing Address - Phone:651-307-1974
Mailing Address - Fax:
Practice Address - Street 1:1432 LAKE ST S
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2635
Practice Address - Country:US
Practice Address - Phone:651-307-1974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist