Individual
JENNIFER LYNN SHEPHERD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, L.I.C.S.W.
Contact information
Practice address
14332 21ST AVE N STE 200, PLYMOUTH, MN 55447-4566
(612) 564-9355
Mailing address
4190 VINEWOOD LANE N, SUITE 111 PMB 403, PLYMOUTH, MN 55442
(612) 564-9355
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
16803
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
071420000
—
MN
Enumeration date
03/06/2008
Last updated
07/18/2024
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