Active NPI
Jessica Underdahl, B.S.
- Mental Health Counselor
- Lebanon, NH
National Provider Identifier
1679173751
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 85 Mechanic St
Lebanon, NH 03766-1537 - Phone
- (036) 448-5610
- NPI assigned
- Oct 28, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
85 Mechanic St
Lebanon, NH 03766-1537
Mailing address
1025 Texas Ave NW Apt F8
Hutchinson, MN 55350-1567
Phone (952) 261-6131
Other practice location 1
225 3rd Ave NW
Hutchinson, MN 55350-1623
Phone (320) 455-9888
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3077550 | Medicaid | NH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor of Science
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Inner Voyage Mental Health PLLC | Current | Accepting new patients | |
| Jacqui Ruzicka Counseling Services, LLC | Current | Accepting new patients | |
| True Balance LTD | Past | Accepting new patients |
Locations
225 3rd Ave NW
Hutchinson, MN 55350
Phone (320) 455-9888
Organizations & group practices 3
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.
-
- Community/Behavioral Health Agency
- Enfield, NH
- NPI 1376384412
-
dba Serenity Mental Health Center
- Community/Behavioral Health Agency
- Hutchinson, MN
- NPI 1669849808
-
- Multi-Specialty Clinic/Center
- Little Falls, MN
- NPI 1205025442
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1612224000000",
"number": "1679173751",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1025 TEXAS AVE NW APT F8",
"city": "HUTCHINSON",
"state": "MN",
"postal_code": "553501567",
"telephone_number": "952-261-6131"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "85 MECHANIC ST",
"city": "LEBANON",
"state": "NH",
"postal_code": "037661537",
"telephone_number": "036-448-5610"
}
],
"practiceLocations": [
{
"address_1": "225 3rd Ave NW",
"address_purpose": "LOCATION",
"city": "Hutchinson",
"state": "MN",
"postal_code": "553501623",
"country_code": "US",
"telephone_number": "320-455-9888",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "UNDERDAHL",
"first_name": "JESSICA",
"credential": "B.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-10-28",
"last_updated": "2021-02-02",
"certification_date": "2021-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3077550",
"state": "NH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lebanon, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.