Individual
DOROTHY LEE JENICKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
STUDENT
Contact information
Practice address
8053 E BLOOMINGTON FWY, BLOOMINGTON, MN 55420-4577
(612) 333-2155
Mailing address
946 HAWTHORNE AVE E, SAINT PAUL, MN 55106-2012
(989) 289-5997
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/25/2021
Last updated
11/13/2024
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