Individual
JESSICA M JACKLITCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
11850 BLACKFOOT ST NW STE 405, COON RAPIDS, MN 55433
(763) 236-0888
(763) 236-0885
Mailing address
3111 124TH AVE NW STE 123, COON RAPIDS, MN 55433-4573
(763) 236-8955
(637) 236-8966
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
7039
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
245J4NO
BCBS - MINNESOTA
MN
01
—
64-03344
MEDICA
MN
01
—
HP43276
HEALTHPARTNERS
MN
Enumeration date
07/31/2006
Last updated
10/29/2018
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