Provider Demographics
NPI:1073800637
Name:KISLING, JESSICA KAY (LPCC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:KAY
Last Name:KISLING
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5412 BERNARD AVE N
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3625
Mailing Address - Country:US
Mailing Address - Phone:612-701-0963
Mailing Address - Fax:
Practice Address - Street 1:12601 RIDGEDALE DR
Practice Address - Street 2:SOCIAL SERVICE CENTER, LEVEL 2
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1911
Practice Address - Country:US
Practice Address - Phone:612-348-7379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00337101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health