Provider Demographics
NPI:1053152157
Name:SORGENFRIE-WACHOLZ, JESSICA JANE (MS, LADC, LPCC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JANE
Last Name:SORGENFRIE-WACHOLZ
Suffix:
Gender:F
Credentials:MS, LADC, LPCC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:JANE-JOHNSON
Other - Last Name:WACHOLZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LADC
Mailing Address - Street 1:1439 15TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-1660
Mailing Address - Country:US
Mailing Address - Phone:507-317-3084
Mailing Address - Fax:
Practice Address - Street 1:1530 ASSISI DR NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-1637
Practice Address - Country:US
Practice Address - Phone:507-218-3462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4448101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional