Provider Demographics
NPI:1053520213
Name:PELLETIER, JENNIFER JEAN (MS, MT-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEAN
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:MS, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 ARCHIBALD LN
Mailing Address - Street 2:
Mailing Address - City:DUNDAS
Mailing Address - State:MN
Mailing Address - Zip Code:55019-3949
Mailing Address - Country:US
Mailing Address - Phone:507-664-9296
Mailing Address - Fax:
Practice Address - Street 1:316 ARCHIBALD LN
Practice Address - Street 2:
Practice Address - City:DUNDAS
Practice Address - State:MN
Practice Address - Zip Code:55019-3949
Practice Address - Country:US
Practice Address - Phone:507-664-9296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist