Provider Demographics
NPI:1114339413
Name:HAEFNER, JESSICA LYNNE (MS LPC-MH, LPCC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNNE
Last Name:HAEFNER
Suffix:
Gender:F
Credentials:MS LPC-MH, LPCC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNNE
Other - Last Name:BROCKEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS LPC-MH, LPCC
Mailing Address - Street 1:30780 128TH ST
Mailing Address - Street 2:
Mailing Address - City:SELBY
Mailing Address - State:SD
Mailing Address - Zip Code:57472-5310
Mailing Address - Country:US
Mailing Address - Phone:605-848-3349
Mailing Address - Fax:
Practice Address - Street 1:1710 E GRAND XING
Practice Address - Street 2:
Practice Address - City:MOBRIDGE
Practice Address - State:SD
Practice Address - Zip Code:57601-1414
Practice Address - Country:US
Practice Address - Phone:605-845-2058
Practice Address - Fax:605-845-2062
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPCMH2303101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health