Basic Information
Provider Information
NPI: 1962784462
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOBBS
FirstName: JENNIFER
MiddleName: D. J,
NamePrefix: DR.
NameSuffix:  
Credential: PSY.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1360 ENERGY PARK DR
Address2: 340
City: SAINT PAUL
State: MN
PostalCode: 551085276
CountryCode: US
TelephoneNumber: 6516468985
FaxNumber:  
Practice Location
Address1: 1360 ENERGY PARK DR
Address2: 340
City: SAINT PAUL
State: MN
PostalCode: 551085276
CountryCode: US
TelephoneNumber: 6516468985
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/12/2011
LastUpdateDate: 09/12/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103T00000X  Y Behavioral Health & Social Service ProvidersPsychologist 

No ID Information.


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