Provider Demographics
NPI:1174156145
Name:DANIELSON, JESSICA L (PHD, LPCC, NCC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:PHD, LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 24 AVE S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-9038
Mailing Address - Country:US
Mailing Address - Phone:701-941-0175
Mailing Address - Fax:701-941-3001
Practice Address - Street 1:300 NP AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4871
Practice Address - Country:US
Practice Address - Phone:701-941-0175
Practice Address - Fax:701-941-3001
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND845-8-1-15-330101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional