Provider Demographics
NPI:1699437079
Name:JOCHUM-LINDSTROM, JEANETTE ANN (MS, LPCC, NCC)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:ANN
Last Name:JOCHUM-LINDSTROM
Suffix:
Gender:F
Credentials:MS, LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 6TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-4885
Mailing Address - Country:US
Mailing Address - Phone:320-979-8448
Mailing Address - Fax:
Practice Address - Street 1:507 MINNESOTA AVE WEST
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MN
Practice Address - Zip Code:56484-1068
Practice Address - Country:US
Practice Address - Phone:320-979-8448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC03029101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty