Healthcare Provider Details

I. General information

NPI: 1780038950
Provider Name (Legal Business Name): JESSICA FRESSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8170 OLD CARRIAGE CT
SHAKOPEE MN
55379-3163
US

IV. Provider business mailing address

8170 OLD CARRIAGE CT STE 204
SHAKOPEE MN
55379-3169
US

V. Phone/Fax

Practice location:
  • Phone: 952-373-1401
  • Fax:
Mailing address:
  • Phone: 952-373-1401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: