Individual
JESSICA JOHANNES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPCC, LADC
Contact information
Practice address
7580 160TH ST W, LAKEVILLE, MN 55044-8348
(612) 919-0774
Mailing address
4 PROMISE BLVD, HUDSON, WI 54016-8722
(612) 919-0774
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
304672
MN
101YM0800X
Mental Health Counselor
Primary
CC02086
MN
Other
Enumeration date
03/31/2019
Last updated
03/31/2019
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