Active NPI
Jackie Harrison
- Addiction (Substance Use Disorder) Counselor
- Minnetonka, MN
National Provider Identifier
1902295306
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 1796
- Practice address
- 12708 Wayzata Blvd
Suite 412
Minnetonka, MN 55305-1916 - Phone
- (763) 443-4562
- NPI assigned
- Jan 22, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1796 | MN | Primary |
Addresses
Primary practice location
12708 Wayzata Blvd
Suite 412
Minnetonka, MN 55305-1916
Mailing address
12708 Wayzata Blvd
Suite 412
Minnetonka, MN 55305-1916
Phone (763) 443-4562
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 |
|---|---|---|---|
| 1796 | MN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437609600000",
"number": "1902295306",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12708 WAYZATA BLVD",
"address_2": "SUITE 412",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553051916",
"telephone_number": "763-443-4562"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12708 WAYZATA BLVD",
"address_2": "SUITE 412",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553051916",
"telephone_number": "763-443-4562"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRISON",
"first_name": "JACKIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-01-22",
"last_updated": "2015-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MN",
"license": "1796",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minnetonka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.