Provider Demographics
NPI:1194191429
Name:DELANE, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DELANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 6TH ST SW
Mailing Address - Street 2:
Mailing Address - City:SAINT STEPHEN
Mailing Address - State:MN
Mailing Address - Zip Code:56375-9665
Mailing Address - Country:US
Mailing Address - Phone:320-250-7371
Mailing Address - Fax:
Practice Address - Street 1:427 6TH ST SW
Practice Address - Street 2:
Practice Address - City:SAINT STEPHEN
Practice Address - State:MN
Practice Address - Zip Code:56375-9665
Practice Address - Country:US
Practice Address - Phone:320-250-7371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104770225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist