MEDICARE: JESSICA L BACHAUS

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
1	101YP2500X	Professional Counselor	4717	MN

General Provider Information

NPI Number	:	1780490177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA L BACHAUS

Provider Business Mailing Address
First Line	:	7600 PARKLAWN AVE STE 380
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-5156
Country	:	US
Telephone Number	:	612-203-2961
Fax Number	:

Provider Business Practice Location Address
First Line	:	7600 PARKLAWN AVE STE 380
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-5156
Country	:	US
Telephone Number	:	612-203-2961
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2024
Last Update Date	:	12/10/2024

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Directions to “ JESSICA L BACHAUS ” Practice Location

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