JENNY MARIE HENDRICKSON (NPI# 1104328111) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104328111 |
| Entity Type | Individual |
| Full Name | JENNY MARIE HENDRICKSON |
| Credential | RDH, DT |
| Practice Address |
918 Market St Perham MN 56573-2118 |
| Practice Telephone | 2183467186 |
| Practice Fax Number | 2183467182 |
| Mailing Telephone | 2183467186 |
| Mailing Fax Number | 2183467182 |
| Enumeration Date | 2018-03-06 |
| Last Update Date | 2018-03-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 125J00000X | Dental Therapist | DT99 | MN | Dental Providers |
| Street Address |
918 MARKET ST |
| City | PERHAM |
| State | MN |
| Zip Code | 56573-2118 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134300098 | Perham Family Dentistry | Clinic/Center | 918 Market St, Perham, MN 56573-2118 | 2007-11-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558630012 | Perham Hospital District | Durable Medical Equipment & Medical Supplies | 1000 Coney Street West, Perham, MN 56573 | 2011-12-29 |
| 1730239385 | Dr. Kelvin K. Salathe, P.C. | Chiropractor | 101 West Coney St, Perham, MN 56573 | 2007-01-12 |
| 1124106299 | Langen Family Chiropractic, P.a. | Chiropractor | 108 Market Dr., Perham, MN 56573 | 2006-11-02 |
| 1285710335 | James Odin Langen | Chiropractor | 108 Market Drive, Perham, MN 56573 | 2006-10-31 |
| 1578572202 | Michael L Hamann | Dentist | 200 1st Ave S, Perham, MN 56573 | 2006-08-05 |
| 1033133517 | Timothy Charles Neitzke | Optometrist | 340 Fox St, Perham, MN 56573 | 2006-07-27 |
| 1023063757 | Shopko Stores Operating Co LLC | Pharmacy | 300 Jake St, Perham, MN 56573 | 2006-05-23 |
| 1164917233 | Katlin Larson | Behavior Technician | 735 3rd St Sw, Perham, MN 56573 | 2018-06-29 |
| 1104029347 | Tammy L Sturdevant | Dentist | 335 4th Ave, Perham, MN 56573 | 2007-06-06 |
| 1861610131 | Minnesota Eyecare Network Inc. | Eyewear Supplier (Equipment, not the service) | 340 Fox Street, Perham, MN 56573 | 2007-04-23 |
| Find all providers in zip 56573 | ||||
| Taxonomy Code | 125J00000X |
| Grouping | Dental Providers |
| Classification | Dental Therapist |
| A Dental Therapist is an individual who has completed an accredited or non-accredited dental therapy program and who has been authorized by the relevant state board or a tribal entity to provide services within the scope of their practice under the supervision of a dentist. Functions that may be delegated to the dental therapist vary based on the needs of the dentist, the educational preparation of the dental therapist and state dental practice acts and regulations. |
| Notes: Source: Summarized from Minnesota Statute 150A.105. [7/1/2012: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487264446 | Amber Nichelle Irby | Dental Therapist | 903 W Center St #130, Rochester, MN 55902 | 2020-08-05 |
| 1558835942 | Jennifer Iacobelli | Dental Therapist | 13899 Highway 13 South Frontage Road, Savage, MN 55378 | 2019-01-18 |
| 1992288781 | Katie Ask | Dental Therapist | 13889 Highway 13 S, Frontage Rd, Savage, MN 55378 | 2018-09-08 |
| 1487154092 | Sunny Moon | Dental Therapist | 10584 France Ave S, Bloomington, MN 55431-3538 | 2018-02-20 |
| 1326548454 | Julie Bonham | Dental Therapist | 803 3rd St. Se, Suite 330, Little Falls, MN 56345 | 2018-02-15 |
| 1376077974 | Saritha Gajawada | Dental Therapist | 15354 Plumstone Dr, Eden Prairie, MN 55347-2061 | 2017-04-20 |
| 1649644063 | Brittany Gronland | Dental Therapist | 25730 Smithtown Rd, Excelsior, MN 55331-8592 | 2015-11-23 |
| 1124405857 | Jenna Susanne Marquardt | Dental Therapist | 209 South 1st Street, Montevideo, MN 56265 | 2015-05-01 |
| 1558751495 | Weston Mark Schmidt | Dental Therapist | 411 East Howard St., Jacobson Family Dentistry PC, Hibbing, MN 55746 | 2015-01-30 |
| 1003230137 | Janelle Jehn | Dental Therapist | 4342 4th Ave S, Minneapolis, MN 55409-2155 | 2014-02-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.