Provider Demographics
NPI:1740715069
Name:BJORLIE, JESSICA ANN
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:BJORLIE
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 1:418 9TH ST N
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:MN
Mailing Address - Zip Code:56215-1433
Mailing Address - Country:US
Mailing Address - Phone:320-368-2757
Mailing Address - Fax:
Practice Address - Street 1:450 9TH AVE
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56241-1326
Practice Address - Country:US
Practice Address - Phone:320-564-4081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2255A2300X, 390200000X
MN32572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program