Provider Demographics
NPI:1316236623
Name:HARRIS, JESSICA (LADC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 UNIVERSITY AVE SE
Mailing Address - Street 2:202
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3232
Mailing Address - Country:US
Mailing Address - Phone:612-638-2282
Mailing Address - Fax:
Practice Address - Street 1:2800 UNIVERSITY AVE SE
Practice Address - Street 2:202
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-3232
Practice Address - Country:US
Practice Address - Phone:612-638-2282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302422101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)