Jessica Rae Moench, LADC, OWNER/DIRECTOR

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

302886 Issued in MN

Practice address

1000 8TH St SE Ste a
Detroit Lakes, MN 56501-2819

Phone

(218) 847-0696

Fax

(218) 847-4198

NPI assigned

Aug 23, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jesola Inc

  • Addiction (Substance Use Disorder) Counselor
  • Detroit Lakes, MN
  • NPI 1861497190
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1282521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732060800000",
    "number": "1104132505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 8TH ST SE STE A",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565012819",
            "telephone_number": "218-847-0696",
            "fax_number": "218-847-4198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 8TH ST SE STE A",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565012819",
            "telephone_number": "218-847-0696",
            "fax_number": "218-847-4198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOENCH",
        "first_name": "JESSICA",
        "middle_name": "RAE",
        "credential": "LADC, OWNER/DIRECTOR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-23",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "302886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emma Amanda Mirembe
• Amanda Mischke
• Amy April Missling, PSYD,LP
• Kathyrn J Moe, CDE
• Andrew Moen, D.P.M.
• Ashley Mohn, LICSW
• Kayli Marie Mollberg, PT
• Angela Jean Moothart, RN
• Manuel R. Moran, M.D.
• Morrison Eye Care Optometrists, P.a.

• Addiction (Substance Use Disorder) Counselor in Detroit Lakes, MN
• Providers in Detroit Lakes, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.