Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 30 days.

JEFFRY R PENWARDEN PHD, LP
NPI 1871544478
Psychologist - Clinical in Forest Lake, MN

Q: What is Jeffry Penwarden's NPI number?

The NPI number for Jeffry Penwarden is 1871544478. It was assigned to this individual provider in the NPPES registry on May 16, 2006.

Q: What is Jeffry Penwarden's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: When was this NPI record last updated?

The NPPES record for Jeffry Penwarden was last updated on July 13, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since May 16, 2006

1540 LAKE ST S, FOREST LAKE, MN 55025(651) 464-7100(651) 982-5515 Get Directions Write a Review

NPPES record last updated: July 13, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Jeffry R Penwarden Phd, Lp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JEFFRY R PENWARDEN PHD, LP (NPI 1871544478) is an individual clinical provider in Forest Lake, Minnesota, licensed in Minnesota (LP2545) and active in the NPI registry since May 2006.

NPPES Registry Identity

NPI1871544478

Entity TypeIndividualMale

Primary Taxonomy103TC0700X

Provider Legal NameJEFFRY R PENWARDENCredential: PHD, LP

Location Address1540 LAKE ST SForest Lake, MN 55025-2628

Mailing Address2925 Chicago AveMinneapolis, MN 55407-1321 · (612) 262-4813 · Fax (612) 262-4194

Phone(651) 464-7100

Fax(651) 982-5515

Sole ProprietorNo

Enumeration DateMay 16, 2006

Last NPPES UpdateJuly 13, 2026

✔ NPI 1871544478 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in MN · LP2545

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

1540 LAKE ST S, Forest Lake, MN 55025

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