Individual
JESSICA UNDERDAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.S.
Contact information
Practice address
85 MECHANIC ST, LEBANON, NH 03766-1537
(036) 448-5610
Mailing address
1025 TEXAS AVE NW APT F8, HUTCHINSON, MN 55350-1567
(952) 261-6131
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3077550
—
NH
Enumeration date
10/28/2020
Last updated
02/02/2021
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