Provider Demographics
NPI:1225650815
Name:WINKELS-HAGERL, JESSICA (LCPP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WINKELS-HAGERL
Suffix:
Gender:F
Credentials:LCPP
Other - Prefix:
Other - First Name:JESICA
Other - Middle Name:
Other - Last Name:WINKELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:324 W SUPERIOR ST STE 400
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1726
Mailing Address - Country:US
Mailing Address - Phone:218-733-3000
Mailing Address - Fax:218-733-3079
Practice Address - Street 1:324 W SUPERIOR ST STE 400
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1726
Practice Address - Country:US
Practice Address - Phone:218-733-3000
Practice Address - Fax:218-733-3079
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC02457101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1790826550Medicaid