Individual
SCOT H. JAENICKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
A.T.C.
Contact information
Practice address
4080 W BROADWAY AVE, SUITE 300, ROBBINSDALE, MN 55422-5604
(763) 533-0341
Mailing address
13607 COUNTRY LN, BURNSVILLE, MN 55337-4133
(952) 898-2146
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
05/01/2007
Last updated
07/08/2007
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