Provider Demographics
NPI:1487059689
Name:MASON, JENNIFER (MA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12750 NICOLLET AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4468
Mailing Address - Country:US
Mailing Address - Phone:651-300-3500
Mailing Address - Fax:
Practice Address - Street 1:12750 NICOLLET AVE STE 215
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4468
Practice Address - Country:US
Practice Address - Phone:651-300-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2025-05-06
Deactivation Date:2018-06-15
Deactivation Code:
Reactivation Date:2018-07-31
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist