Provider Demographics
NPI:1801392410
Name:HAAS, JESSICA MARGARET (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARGARET
Last Name:HAAS
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 GRAND AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-2744
Mailing Address - Country:US
Mailing Address - Phone:651-829-3568
Mailing Address - Fax:877-292-0677
Practice Address - Street 1:1123 GRAND AVE APT 203
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-2744
Practice Address - Country:US
Practice Address - Phone:651-829-3568
Practice Address - Fax:877-292-0677
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3629106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist