Provider Demographics
NPI:1780149583
Name:HELGESON, JESSE JAMES
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:JAMES
Last Name:HELGESON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 3RD ST SW
Mailing Address - Street 2:
Mailing Address - City:PELICAN RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56572-4437
Mailing Address - Country:US
Mailing Address - Phone:218-671-0994
Mailing Address - Fax:
Practice Address - Street 1:1711 6TH ST S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-3438
Practice Address - Country:US
Practice Address - Phone:800-593-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT560213931811OtherDRIVER'S LICENSE