Provider Demographics
NPI:1215296892
Name:PUNDSACK, JOLENE ANNA (MS, LPCC,)
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:ANNA
Last Name:PUNDSACK
Suffix:
Gender:F
Credentials:MS, LPCC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 BROADWAY ST STE 206
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-1482
Mailing Address - Country:US
Mailing Address - Phone:320-762-1762
Mailing Address - Fax:320-762-0796
Practice Address - Street 1:324 BROADWAY ST STE 206
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-1482
Practice Address - Country:US
Practice Address - Phone:320-762-1762
Practice Address - Fax:320-762-0796
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00476101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health