Individual
MS. CHANTELLE JESSICA HOOGLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC, LADC
Contact information
Practice address
250 PRAIRIE CENTER DR STE 202, EDEN PRAIRIE, MN 55344-7911
(952) 388-9204
Mailing address
2650 WOODS DR, VICTORIA, MN 55386-3401
(952) 388-9204
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
304850
MN
101YP2500X
Professional Counselor
Primary
CC01230
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101076
DRUG MEDI-CAL BILLING #
CA
Enumeration date
02/23/2007
Last updated
05/04/2018
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