Individual
JENNIFER M RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
2249 OAK GLEN DR, STILLWATER, MN 55082-9631
(651) 492-4834
(651) 344-1966
Mailing address
PO BOX 62, STILLWATER, MN 55082-0062
(651) 492-4834
(651) 344-1966
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
1359
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116942
HEALTHPARTNERS
MN
01
—
735398700
MHCP
MN
01
—
78G84IN
BLUECROSS BLUE SHIELD
MN
01
—
78G85RU
BLUECROSS BLUE SHIELD
MN
Enumeration date
01/04/2007
Last updated
07/08/2007
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