Provider Demographics
NPI:1942024021
Name:MENZ, JENNA M (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:M
Last Name:MENZ
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:M
Other - Last Name:GRANNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10621 165TH ST W
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-3520
Mailing Address - Country:US
Mailing Address - Phone:507-430-8722
Mailing Address - Fax:763-210-6886
Practice Address - Street 1:10621 165TH ST W
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-3520
Practice Address - Country:US
Practice Address - Phone:763-210-9966
Practice Address - Fax:763-210-6886
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN313021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical