Provider Demographics
NPI:1407819758
Name:DEWEY, JESSICA A (LADC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:A
Last Name:DEWEY
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:DEWEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA, LADC
Mailing Address - Street 1:31682 COUNTY 2
Mailing Address - Street 2:
Mailing Address - City:SHEVLIN
Mailing Address - State:MN
Mailing Address - Zip Code:56676-4078
Mailing Address - Country:US
Mailing Address - Phone:218-785-2900
Mailing Address - Fax:
Practice Address - Street 1:1510 BEMIDJI AVE N
Practice Address - Street 2:SUITE #13
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3800
Practice Address - Country:US
Practice Address - Phone:218-444-5740
Practice Address - Fax:218-333-0241
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300140101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)