Provider Demographics
NPI:1487762837
Name:ROCHELEAU DORHOLT, JENNIFER KAY (PSYD, LP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:KAY
Last Name:ROCHELEAU DORHOLT
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:KAY
Other - Last Name:ROCHELEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD, LP
Mailing Address - Street 1:720 4TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4498
Mailing Address - Country:US
Mailing Address - Phone:320-308-3171
Mailing Address - Fax:320-308-0959
Practice Address - Street 1:720 4TH AVE S
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4498
Practice Address - Country:US
Practice Address - Phone:320-308-3171
Practice Address - Fax:320-308-0959
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4779103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical