Provider Demographics
NPI:1194440024
Name:JORGENSEN-KUPHAL, JENNY LYNN (MA)
Entity type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:LYNN
Last Name:JORGENSEN-KUPHAL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 S OAK AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-3957
Mailing Address - Country:US
Mailing Address - Phone:507-676-6834
Mailing Address - Fax:
Practice Address - Street 1:1414 S OAK AVE STE 6
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-3957
Practice Address - Country:US
Practice Address - Phone:507-676-6834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health