Provider Demographics
NPI:1467940718
Name:JEZIERSKI, KELSEY L (MA LPCC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:L
Last Name:JEZIERSKI
Suffix:
Gender:F
Credentials:MA LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 JACKSON ST NE STE 105
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1665
Mailing Address - Country:US
Mailing Address - Phone:612-874-7063
Mailing Address - Fax:
Practice Address - Street 1:1121 JACKSON ST NE STE 105
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1665
Practice Address - Country:US
Practice Address - Phone:612-874-7063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MN2991101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor