Provider Demographics
NPI:1851537542
Name:CONELL, JESSICA J (BS, LAC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:J
Last Name:CONELL
Suffix:
Gender:F
Credentials:BS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 CONTINENTAL DR
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-6565
Mailing Address - Country:US
Mailing Address - Phone:406-782-4778
Mailing Address - Fax:
Practice Address - Street 1:2510 CONTINENTAL DR
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-6565
Practice Address - Country:US
Practice Address - Phone:406-782-4778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1283101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)