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Individual

STACIA JEPPSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
3018 LAKE SHORE DR, MINNEAPOLIS, MN 55416-4282
(320) 493-8522
Mailing address
225 MURIEFIELD DR, MANKATO, MN 56001-7568
(320) 493-8522

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
CC02209
MN
390200000X
Student in an Organized Health Care Education/Training Program
411946275
MN

Other

Enumeration date
10/21/2014
Last updated
10/08/2020
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