Provider Demographics
NPI:1124519996
Name:CHRISTY, JENNIFER LEE (MS, MT-BC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEE
Last Name:CHRISTY
Suffix:
Gender:F
Credentials:MS, MT-BC
Other - Prefix:MS
Other - First Name:JENN
Other - Middle Name:
Other - Last Name:CHRISTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, MT-BC
Mailing Address - Street 1:3100 VIRGINIA AVE S APT 302
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-3669
Mailing Address - Country:US
Mailing Address - Phone:208-484-1748
Mailing Address - Fax:
Practice Address - Street 1:3100 VIRGINIA AVE S APT 302
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-3669
Practice Address - Country:US
Practice Address - Phone:208-484-1748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-28
Last Update Date:2018-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist