Active NPI
Jessica Effertz
- Counselor
- Blaine, MN
National Provider Identifier
1750258364
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 1790017721
- Practice address
- 12840 Fillmore St NE
Blaine, MN 55434-4049 - Phone
- (612) 913-8411
- NPI assigned
- Oct 20, 2025
- Last updated
- Oct 20, 2025
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 1992903991 | MN | |
| Counselor | 101Y00000X | 1790017721 | MN | Primary |
Addresses
Primary practice location
12840 Fillmore St NE
Blaine, MN 55434-4049
Mailing address
12840 Fillmore St NE
Blaine, MN 55434-4049
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1790017721 | MN | MD | Counselor |
| 1992903991 | MN | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1760918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1760918400000",
"number": "1750258364",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12840 FILLMORE ST NE",
"city": "BLAINE",
"state": "MN",
"postal_code": "554344049"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12840 FILLMORE ST NE",
"city": "BLAINE",
"state": "MN",
"postal_code": "554344049",
"telephone_number": "612-913-8411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EFFERTZ",
"first_name": "JESSICA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-10-20",
"last_updated": "2025-10-20",
"certification_date": "2025-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "MN",
"license": "1992903991",
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "MN",
"license": "1790017721",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Blaine, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.