Jennifer Ann Gullickson, MS, LPCC, NCC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

CC01875 Issued in MN

Practice address

400 E 1St St
Morris, MN 56267-1408

Phone

(320) 589-1313

NPI assigned

Sep 11, 2018

Last updated

Jan 20, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Jennifer Ann Petersen Former name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Glacial Ridge Hospital DistrictGroup PAC ID 5294789194, shared by 7 NPIs, 69 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-usa.unify.chbase.com/org/glac-1755385c

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

• Glacial Ridge Hospital District

  dba Brooten Medical Center

  • Family Medicine Physician
  • Brooten, MN
  • NPI 1255348223
  Medicare reassignment NPD
• Glacial Ridge Hospital District

  • Critical Access Hospital
  • Glenwood, MN
  • NPI 1538178520
  Medicare reassignment NPD
• Stevens Community Medical Center Inc.

  dba Starbuck Clinic

  • Clinic/Center
  • Starbuck, MN
  • NPI 1417105552
  Medicare reassignment NPD
• Glacial Ridge Hospital District

  dba Starbuck Medical Center

  • Rural Health Clinic/Center
  • Starbuck, MN
  • NPI 1063952026
  NPD
• Glacial Ridge Hospital District

  dba Glenwood Family Eye Center

  • Optometrist
  • Glenwood, MN
  • NPI 1306206446
  NPD
• Stevens Community Medical Center Inc

  • Critical Access Hospital
  • Morris, MN
  • NPI 1487678942
  NPD
• Stevens Community Medical Center Inc

  dba Stevens Community Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Morris, MN
  • NPI 1649705690
  NPD

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

{
    "created_epoch": "1536624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674172800000",
    "number": "1760965156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 1ST ST",
            "city": "MORRIS",
            "state": "MN",
            "postal_code": "562671408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E 1ST ST",
            "city": "MORRIS",
            "state": "MN",
            "postal_code": "562671408",
            "telephone_number": "320-589-1313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GULLICKSON",
        "first_name": "JENNIFER",
        "middle_name": "ANN",
        "credential": "MS, LPCC, NCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-11",
        "last_updated": "2023-01-20",
        "certification_date": "2023-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MN",
            "license": "CC01875",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "CC01875",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC01875",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "PETERSEN",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Andrea Giambi, DO
• Amee Gibson, DPM
• Jenny Gibson, PHARMD
• Edward Green, MD
• James W Green, MD
• Randy Lynn Hamling, D.C.
• Paige W Hardy, CNM
• Jeffrey Andrew Hauger, DDS
• Franchetta Haupert
• Jerry Reed Hendel, MD

• Counselor in Morris, MN
• Providers in Morris, MN by specialty
• Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.