Provider Demographics
NPI:1073993341
Name:GOURNEAU, JESSICA LYNN (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LYNN
Last Name:GOURNEAU
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 METRO BLVD
Mailing Address - Street 2:STE 525
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3059
Mailing Address - Country:US
Mailing Address - Phone:651-793-3803
Mailing Address - Fax:651-793-3809
Practice Address - Street 1:579 WELLS ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-4134
Practice Address - Country:US
Practice Address - Phone:651-793-3803
Practice Address - Fax:651-793-3809
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 8592103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical