Individual
JACKIE HARRISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12708 WAYZATA BLVD, SUITE 412, MINNETONKA, MN 55305-1916
(763) 443-4562
Mailing address
12708 WAYZATA BLVD, SUITE 412, MINNETONKA, MN 55305-1916
(763) 443-4562
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1796
MN
Other
Enumeration date
01/22/2015
Last updated
07/23/2015
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