Dorothy Lee Jenicke, STUDENT

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

8053 E Bloomington Fwy
Bloomington, MN 55420-4577

Phone

(612) 333-2155

NPI assigned

Aug 25, 2021

Last updated

Nov 13, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mrs Acquisition Corporation

  dba Metropolitain Rehabilitation Services

  • Psychologist
  • Bloomington, MN
  • NPI 1497599724
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731456000000",
    "number": "1053088245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "946 HAWTHORNE AVE E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551062012",
            "telephone_number": "989-289-5997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8053 E BLOOMINGTON FWY",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554204577",
            "telephone_number": "612-333-2155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENICKE",
        "first_name": "DOROTHY",
        "middle_name": "LEE",
        "credential": "STUDENT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-25",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Khalid Jedal
• Robert J Jeddeloh, M.D.
• Jeff Shively, MSW, Licsw
• Lilli Ann Jeffrey-Smith, PH.D.
• Anastasia Jellison
• Jacob Ray Jenness, OD
• Amy Jo Jensen, OTR
• Christina Jean Jensen, OT
• Heather Lynn Jensen, DPM, MHA
• Martina Jensen, LICSW

• Student in an Organized Health Care Education/Training Program in Bloomington, MN
• Providers in Bloomington, MN by specialty
• Student in an Organized Health Care Education/Training Program in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.