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Devils Lake, North Dakota

Provider NPI: 1881767960

Provider Information:
Gender: F
Not Sole Proprietor

Practice Location:
Tel: 701-662-6776  Fax: 701-662-6889

Business Mailing Address:
7535 54TH ST NE  PENN, ND 58362 US
Tel: --  Fax: --

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
X101Y00000XBehavioral Health & Social Service Providers
X1041C0700XBehavioral Health & Social Service Providers
Social Worker

Other Provider Identifiers:

MEDICA UBH62-56618ND01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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