Individual
JACLYN HENRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
44 W 66TH ST, RICHFIELD, MN 55423-2316
(612) 873-6963
Mailing address
4828 35TH AVE S, MINNEAPOLIS, MN 55417-1506
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP5918
MN
Other
Enumeration date
07/07/2015
Last updated
11/09/2015
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