Provider Demographics
NPI:1215264320
Name:SWEENEY, JENNIE (LAC)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1534 COTTAGE DR
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-5962
Mailing Address - Country:US
Mailing Address - Phone:651-253-5712
Mailing Address - Fax:
Practice Address - Street 1:1 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-2226
Practice Address - Country:US
Practice Address - Phone:715-736-1014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI645055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist