Individual
JENNIFER LYNN MANNIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
7300 147TH ST W STE 204, APPLE VALLEY, MN 55124-7850
(952) 997-3020
Mailing address
9586 198TH ST W, LAKEVILLE, MN 55044-4782
(651) 206-6606
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
302202
MN
Other
Enumeration date
10/03/2022
Last updated
10/03/2022
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