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NPI Code Detail

MEDICARE: JESSICA LYNN LUNDQUIST LPCC

MEDICARE: JESSICA LYNN LUNDQUIST LPCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorCC02195MN

General Provider Information

NPI Number : 1578111977
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA LYNN LUNDQUIST LPCC
Provider Business Mailing Address
First Line : 4137 SAARI RD
Second Line :
City : HIBBING
State : MN
Zip : 55746-8251
Country : US
Telephone Number : 218-966-0450
Fax Number :
Provider Business Practice Location Address
First Line : 2932 1ST AVE
Second Line :
City : HIBBING
State : MN
Zip : 55746-2564
Country : US
Telephone Number : 218-966-0450
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2019
Last Update Date : 08/28/2019

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Directions to “ JESSICA LYNN LUNDQUIST LPCC” Practice Location

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