Provider Demographics
NPI:1912655333
Name:FAHLAND, JENNA (MA LPCC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:FAHLAND
Suffix:
Gender:F
Credentials:MA LPCC
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:YOUNKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA LPCC
Mailing Address - Street 1:655 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:RUSH CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55069-5034
Mailing Address - Country:US
Mailing Address - Phone:715-613-2699
Mailing Address - Fax:
Practice Address - Street 1:655 W 12TH ST
Practice Address - Street 2:
Practice Address - City:RUSH CITY
Practice Address - State:MN
Practice Address - Zip Code:55069-5034
Practice Address - Country:US
Practice Address - Phone:715-613-2699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1356101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health