Provider Demographics
NPI:1477332443
Name:PLAISTED, JESSICA (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PLAISTED
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41332 COUNTY ROAD 603
Mailing Address - Street 2:
Mailing Address - City:NASHWAUK
Mailing Address - State:MN
Mailing Address - Zip Code:55769-4149
Mailing Address - Country:US
Mailing Address - Phone:218-966-2384
Mailing Address - Fax:
Practice Address - Street 1:2310 NW 3RD ST
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-2135
Practice Address - Country:US
Practice Address - Phone:218-328-3214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical