Provider Demographics
NPI:1225134240
Name:JESSE, VERNON CLAUDE (PHD LP)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:CLAUDE
Last Name:JESSE
Suffix:
Gender:M
Credentials:PHD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2497 7TH AVE E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTH ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2496
Mailing Address - Country:US
Mailing Address - Phone:651-769-6437
Mailing Address - Fax:651-769-6426
Practice Address - Street 1:1185 TOWN CENTRE DR
Practice Address - Street 2:SUITE 225
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-1186
Practice Address - Country:US
Practice Address - Phone:651-769-6200
Practice Address - Fax:651-769-6249
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0884103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical