Provider Demographics
NPI:1124175187
Name:HUTCHINSON, JENNA RAE KOHLES (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:RAE KOHLES
Last Name:HUTCHINSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5319 KNOX AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-1043
Mailing Address - Country:US
Mailing Address - Phone:612-926-7778
Mailing Address - Fax:
Practice Address - Street 1:807 BROADWAY ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2332
Practice Address - Country:US
Practice Address - Phone:612-668-8693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN252403103TS0200X
MNLP1514103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist