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Individual

JESSICA ELLISON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1521 HIGHWAY 13 E, BURNSVILLE, MN 55337-2917
(612) 964-8477
Mailing address
1521 HIGHWAY 13 E, BURNSVILLE, MN 55337-2917
(612) 964-8477

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
01268
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01268
LICENSE
MN
Enumeration date
07/19/2016
Last updated
07/19/2016
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