Individual
DR. JENNIFER STOLTENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD, LP
Contact information
Practice address
2265 COMO AVE, SAINT PAUL, MN 55108-1737
(651) 645-5323
Mailing address
2265 COMO AVE, SAINT PAUL, MN 55108-1737
(651) 645-5323
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6336
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LJUXZ5625339
BLUE CROSS BLUE SHIELD
MN
Enumeration date
12/01/2015
Last updated
11/28/2018
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