Individual
MRS. JENNIFER ANN ULLOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LP
Contact information
Practice address
700 TWELVE OAKS CENTER DR, STE 204, WAYZATA, MN 55391-4415
(612) 306-8499
(651) 374-9641
Mailing address
7513 INLAND LN N, MAPLE GROVE, MN 55311-3954
(612) 998-5162
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
LPP161LP5067
MN
103TC1900X
Counseling Psychologist
Primary
LP5067
MN
Other
Enumeration date
05/30/2007
Last updated
08/18/2020
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