Healthcare Provider Details

I. General information

NPI: 1568328565
Provider Name (Legal Business Name): JESSICA RAE MOHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 RIVER RD
GRAND RAPIDS MN
55744-4085
US

IV. Provider business mailing address

315 6TH AVE STE 293
BOVEY MN
55709-2636
US

V. Phone/Fax

Practice location:
  • Phone: 218-372-3000
  • Fax:
Mailing address:
  • Phone: 218-327-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number305533
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number31252
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: