Provider Demographics
NPI:1588072573
Name:MITTELSTAEDT, JESSICA (MA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MITTELSTAEDT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14451 HIGHWAY 7
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-3740
Mailing Address - Country:US
Mailing Address - Phone:612-460-1791
Mailing Address - Fax:
Practice Address - Street 1:14451 HIGHWAY 7
Practice Address - Street 2:SUITE 2A
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-3740
Practice Address - Country:US
Practice Address - Phone:612-460-1791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist