Basic Information
| Provider Information | |||||||||
| NPI: | 1003141979 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOZY | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | RENE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSYD, LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2430 NICOLLET AVE S | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554043461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128711454 | ||||||||
| FaxNumber: | 9529120554 | ||||||||
| Practice Location | |||||||||
| Address1: | 7601 WAYZATA BLVD | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554261626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122238898 | ||||||||
| FaxNumber: | 6122238899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2009 | ||||||||
| LastUpdateDate: | 09/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | LP5159 | MN | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.