Jennifer Marie Lake, M.A., LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

2425 Issued in MN

Practice address

2233 N. Hamline Ave., Suite 411
Roseville, MN 55113

Phone

(612) 799-8258

Fax

(651) 330-8718

NPI assigned

Dec 6, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Jennifer Marie Ketz Former name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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 and National Provider Directory roles.

• Turning Leaf Therapy

  • Community/Behavioral Health Agency
  • Roseville, MN
  • NPI 1124471107

  MN

  Medicare reassignment Care Compare group NPD Authorized official

Specialty

Marriage and Family Therapist

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Turning Leaf Therapy 10 clinicians

Practice addresses (Care Compare)

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

{
    "created_epoch": "1291593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445472000000",
    "number": "1801199302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8119 50TH AVE. N.",
            "city": "NEW HOPE",
            "state": "MN",
            "postal_code": "55428",
            "telephone_number": "612-799-8258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2233 N. HAMLINE AVE., SUITE 411",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "55113",
            "telephone_number": "612-799-8258",
            "fax_number": "651-330-8718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "JENNIFER",
        "middle_name": "MARIE",
        "credential": "M.A., LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-12-06",
        "last_updated": "2015-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "2425",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "KETZ",
            "middle_name": "MARIE",
            "credential": "MA, LMFT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Juhee Kwon, MA, LPCC
• Louise Mae L'Allier, LMFT
• Brett David Lackie, DPT
• Steve Michael Lafond, PHARMD
• Lake Josephine Family Dental LLC
• Katherine Hailey Lake, OTR/L
• David P Lambert, MD
• Elizabeth Lanari, LMFT
• Harlie Lane
• Nicholas Lange, MD

• All providers in Roseville, MN
• Marriage & Family Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.