Provider Demographics
NPI:1447772249
Name:JESSEN, KATLYN JO (LPCC)
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:JO
Last Name:JESSEN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-6442
Mailing Address - Country:US
Mailing Address - Phone:507-454-4341
Mailing Address - Fax:507-205-4296
Practice Address - Street 1:611 BROADWAY AVE STE 100
Practice Address - Street 2:
Practice Address - City:WABASHA
Practice Address - State:MN
Practice Address - Zip Code:55981
Practice Address - Country:US
Practice Address - Phone:651-565-2235
Practice Address - Fax:651-565-2890
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01561101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional