Healthcare Provider Details

I. General information

NPI: 1154110765
Provider Name (Legal Business Name): GRETA MARIE JESKA LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 8TH ST SE
DETROIT LAKES MN
56501-2839
US

IV. Provider business mailing address

980 S TOWER RD
FERGUS FALLS MN
56537-5505
US

V. Phone/Fax

Practice location:
  • Phone: 218-847-1676
  • Fax: 218-847-1678
Mailing address:
  • Phone: 218-847-1676
  • Fax: 218-847-1678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4938
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: