Provider Demographics
NPI:1740020072
Name:SEILER, JESSICA LYNN (LADC/ LPCC CANDIDATE)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:SEILER
Suffix:
Gender:F
Credentials:LADC/ LPCC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14474 AZTEC ST NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-3199
Mailing Address - Country:US
Mailing Address - Phone:763-528-5253
Mailing Address - Fax:
Practice Address - Street 1:299 COON RAPIDS BLVD NW STE 100
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5869
Practice Address - Country:US
Practice Address - Phone:612-454-0396
Practice Address - Fax:612-446-5766
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty