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Organization
REVIVE WELLNESS
Active
Organization
REVIVE WELLNESS
Active
Other names
Jessica Shockman
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JESSICA NICHOLE SHOCKMAN LICSW (MENTAL HEALTH PROFESSIONAL)
(218) 289-7023
Entity
Organization
Contact information
Practice address
116 W ROBERT ST STE 2B, CROOKSTON, MN 56716-1709
(218) 289-7023
Mailing address
116 W ROBERT ST STE 2B, CROOKSTON, MN 56716-1709
(218) 289-7023
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
01/27/2023
Last updated
01/27/2023
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