Healthcare Provider Details

I. General information

NPI: 1669288775
Provider Name (Legal Business Name): JESSLYNN ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAY ADAMS

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1266
WILLISTON ND
58802-1266
US

IV. Provider business mailing address

316 2ND AVE W
WILLISTON ND
58801-2005
US

V. Phone/Fax

Practice location:
  • Phone: 701-774-4600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2410
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: