| Doctor Name: | JESSICA LYNNE HAEFNER |
| NPI Number: | 1114339413 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S. LPC |
| License Number: | LPC7304 |
| Business Practice Address: | 30780 128th St Selby, SD - 574725310 |
| Business Phone Number: | 6058483349 |
| Business Fax Number: | |
| Mailing Address: | 30780 128th St, SELBY |
| State: | SD |
| Postal Code: | 574725310 |
| Phone Number: | 6058483349 |
| Fax Number: | |
| NPI Enumeration Date: | 05/21/2014 |
| NPI Last Update Date: | 04/25/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LPC7304 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |