Provider Demographics
NPI:1710284120
Name:KARJALAINEN, JESSICA (MA LAC LADC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KARJALAINEN
Suffix:
Gender:F
Credentials:MA LAC LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 40TH ST S
Mailing Address - Street 2:SUITE B
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1184
Mailing Address - Country:US
Mailing Address - Phone:701-478-8440
Mailing Address - Fax:
Practice Address - Street 1:112 UNIVERSITY DR N
Practice Address - Street 2:SUITE 200
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4661
Practice Address - Country:US
Practice Address - Phone:701-566-5272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-21
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303066101YA0400X
ND1697101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN303066OtherSTATE OF MINNESOTA BOARD OF BEHAVIORAL HEALTH AND THERAPY