Provider Demographics
NPI:1043503154
Name:SUNSDAHL, JESSICA LEAH (LAC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEAH
Last Name:SUNSDAHL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:ROLFES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:203 COOPER AVE NORTH
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303
Mailing Address - Country:US
Mailing Address - Phone:320-493-8278
Mailing Address - Fax:866-990-2971
Practice Address - Street 1:203 COOPER AVE NORTH
Practice Address - Street 2:SUITE 160
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-493-8278
Practice Address - Fax:866-990-2971
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1560171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist