Provider Demographics
NPI:1124111745
Name:WESTRUM, JENNIFER LYNN (MS)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:WESTRUM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 17TH ST. SOUTH
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:MN
Mailing Address - Zip Code:56215
Mailing Address - Country:US
Mailing Address - Phone:320-843-4356
Mailing Address - Fax:320-843-4692
Practice Address - Street 1:640 ATLANTIC AVENUE
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:MN
Practice Address - Zip Code:56215
Practice Address - Country:US
Practice Address - Phone:320-843-3454
Practice Address - Fax:320-843-4692
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLPP0073101YP2500X
MNLPC00107101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional