Basic Information
Provider Information
NPI: 1003141979
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GOZY
FirstName: JENNIFER
MiddleName: RENE
NamePrefix: DR.
NameSuffix:  
Credential: PSYD, LP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2430 NICOLLET AVE S
Address2:  
City: MINNEAPOLIS
State: MN
PostalCode: 554043461
CountryCode: US
TelephoneNumber: 6128711454
FaxNumber: 9529120554
Practice Location
Address1: 2430 NICOLLET AVE S
Address2:  
City: MINNEAPOLIS
State: MN
PostalCode: 554043461
CountryCode: US
TelephoneNumber: 6128711454
FaxNumber: 9529120554
Other Information
ProviderEnumerationDate: 10/12/2009
LastUpdateDate: 12/07/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700XLP5159MNY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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