Provider Demographics
NPI:1215792585
Name:BRENNAN, JESSIE JO (CPRSR-FE, CPSS)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:JO
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:CPRSR-FE, CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5305 RUSSELL AVE N APT 114
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2954
Mailing Address - Country:US
Mailing Address - Phone:651-356-9890
Mailing Address - Fax:
Practice Address - Street 1:5305 RUSSELL AVE N APT 114
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55430-2954
Practice Address - Country:US
Practice Address - Phone:651-356-9890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8250175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist