Healthcare Provider Details

I. General information

NPI: 1578431268
Provider Name (Legal Business Name): JELLE CONSULTANT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2025
Last Update Date: 10/25/2025
Certification Date: 10/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 PATRICIA DR
SAINT CLOUD MN
56301-4969
US

IV. Provider business mailing address

1517 PATRICIA DR
SAINT CLOUD MN
56301-4969
US

V. Phone/Fax

Practice location:
  • Phone: 612-913-8134
  • Fax:
Mailing address:
  • Phone: 612-913-8134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HUSSEIN AHMED
Title or Position: OWNER
Credential:
Phone: 612-913-8134