Provider Demographics
NPI:1720589856
Name:KARASEK, JESSICA ANN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:KARASEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:MEADOWLANDS
Mailing Address - State:MN
Mailing Address - Zip Code:55765-0057
Mailing Address - Country:US
Mailing Address - Phone:218-590-7217
Mailing Address - Fax:
Practice Address - Street 1:10342 HIGHWAY 133
Practice Address - Street 2:
Practice Address - City:MEADOWLANDS
Practice Address - State:MN
Practice Address - Zip Code:55765-8133
Practice Address - Country:US
Practice Address - Phone:218-590-7217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency