Individual
JEFFRY R PENWARDEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PHD, LP
Contact information
Practice address
1540 LAKE ST S, FOREST LAKE, MN 55025-2628
(651) 464-7100
(651) 982-5515
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-4813
(612) 262-4194
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP2545
MN
Other
Enumeration date
05/16/2006
Last updated
07/08/2007
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