Provider Demographics
NPI:1144556630
Name:MACKENTHUN, JENNIFER JEAN
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEAN
Last Name:MACKENTHUN
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 1:1221 4TH AVE E
Mailing Address - Street 2:#195
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-1681
Mailing Address - Country:US
Mailing Address - Phone:952-913-7778
Mailing Address - Fax:
Practice Address - Street 1:1221 4TH AVE E
Practice Address - Street 2:#195
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-1681
Practice Address - Country:US
Practice Address - Phone:952-913-7778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist