Provider Demographics
NPI:1043800402
Name:SKLAR, JESSICA (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SKLAR
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19095 51ST PL N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-4634
Mailing Address - Country:US
Mailing Address - Phone:952-212-1330
Mailing Address - Fax:
Practice Address - Street 1:19095 51ST PL N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-4634
Practice Address - Country:US
Practice Address - Phone:952-212-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2716101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health