Provider Demographics
NPI:1427697150
Name:STOWE, JENNIFER LOUISE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LOUISE
Last Name:STOWE
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 1:3311 COUNTY ROAD 101 S STE 3
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-2879
Mailing Address - Country:US
Mailing Address - Phone:612-460-7443
Mailing Address - Fax:
Practice Address - Street 1:3311 COUNTY ROAD 101 S STE 3
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-2879
Practice Address - Country:US
Practice Address - Phone:612-460-7443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-28
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3348106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist