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General NPI Number Information
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NPI Number | 1659623361
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Entity Type | Individual
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Provider Name | JESSICA DRESDEN PSYD, LP
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Gender | Female
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Dates
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Enumeration Date | 10/04/2012
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Last Update Date | 12/28/2018
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Provider Practice Location Address
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Address Line | 760 STILLWATER RD STE 101
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City | MAHTOMEDI
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State | MN
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Zip | 55115-2060
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Country | US
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Telephone | 612-260-5211
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Fax | 651-967-7251
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Provider Business Mailing Address
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Address Line | 760 STILLWATER RD STE 101
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City | MAHTOMEDI
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State | MN
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Zip | 55115-2060
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Country | US
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Telephone | 612-260-5211
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP6055
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License Number State | MN
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