Healthcare Provider Details

I. General information

NPI: 1235914185
Provider Name (Legal Business Name): JILLIAN DEE HASELEU LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JILLIAN DEE KASOWSKI

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 WILCOX AVE N
BUFFALO ND
58011-4027
US

IV. Provider business mailing address

302 WILCOX AVE N
BUFFALO ND
58011-4027
US

V. Phone/Fax

Practice location:
  • Phone: 701-371-5716
  • Fax:
Mailing address:
  • Phone: 107-371-5716
  • Fax: 701-371-5716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1262-2-1-23-615
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: