Individual
JENNIFER CONNOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
11660 ROUND LAKE BLVD NW, COON RAPIDS, MN 55433-2638
(763) 767-3350
Mailing address
11452 KENYON CT NE, BLAINE, MN 55449-5480
(612) 272-7953
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
305835
MN
Other
Enumeration date
10/04/2022
Last updated
10/04/2022
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