Healthcare Provider Details

I. General information

NPI: 1225524721
Provider Name (Legal Business Name): JESSICA MOGER LAWLER MS, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2018
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2056 SCOTT RD NW STE 100
ROCHESTER MN
55901-4518
US

IV. Provider business mailing address

179 STONELAKE DR SE
ROCHESTER MN
55904-6490
US

V. Phone/Fax

Practice location:
  • Phone: 803-216-1645
  • Fax:
Mailing address:
  • Phone: 507-676-5636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4685
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3098
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: