Provider Demographics
NPI:1093725467
Name:ENSTAD, JENNIFER G (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:G
Last Name:ENSTAD
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17730 GIBBON ST NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-5510
Mailing Address - Country:US
Mailing Address - Phone:763-274-2986
Mailing Address - Fax:
Practice Address - Street 1:7372 KIRKWOOD CT
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-5202
Practice Address - Country:US
Practice Address - Phone:763-416-4167
Practice Address - Fax:763-416-4137
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4639103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling