Provider Demographics
NPI:1346907771
Name:AHLSTRAND, JADE NICOLE (MS, NCC, PILT)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:NICOLE
Last Name:AHLSTRAND
Suffix:
Gender:F
Credentials:MS, NCC, PILT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-9000
Mailing Address - Fax:612-262-9035
Practice Address - Street 1:2855 CAMPUS DR STE 660
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2665
Practice Address - Country:US
Practice Address - Phone:763-577-7900
Practice Address - Fax:763-577-7905
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MN4098101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program