Provider Demographics
NPI:1093607616
Name:ERICKSON, JENNY ELLEN (LMT)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:ELLEN
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6485 CITY WEST PKWY
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3246
Mailing Address - Country:US
Mailing Address - Phone:952-933-1150
Mailing Address - Fax:952-933-1150
Practice Address - Street 1:6485 CITY WEST PKWY
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3246
Practice Address - Country:US
Practice Address - Phone:952-933-1150
Practice Address - Fax:952-933-1150
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist