Provider Demographics
NPI:1417142332
Name:UDESEN, JEAN LINDA
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:LINDA
Last Name:UDESEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JEAN
Other - Middle Name:LINDA
Other - Last Name:BURKLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 WINDSOR LANE
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112
Mailing Address - Country:US
Mailing Address - Phone:651-631-2127
Mailing Address - Fax:
Practice Address - Street 1:1485 81ST AVENUE NORTH EAST
Practice Address - Street 2:
Practice Address - City:SPRING LAKE PARK
Practice Address - State:MN
Practice Address - Zip Code:55432
Practice Address - Country:US
Practice Address - Phone:763-780-3036
Practice Address - Fax:763-780-0784
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling