Active NPI
Jennifer Jo Faul, LCSW IN ND LGSW IN M
- Clinical Social Worker
- Moorhead, MN
National Provider Identifier
1043385032
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 11233
- Practice address
- 2925 20TH St S
Moorhead, MN 56560 - Phone
- (218) 284-0300
- Fax
- (218) 284-5944
- NPI assigned
- Nov 22, 2006
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 2994 | ND | |
| Clinical Social Worker | 1041C0700X | 11233 | MN | Primary |
Addresses
Primary practice location
2925 20TH St S
Moorhead, MN 56560
Mailing address
PO Box 111
Davenport, ND 58021
Phone (701) 371-6550
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10677 | Medicaid | ND | |
| 338K3FA | Other | MN | BCBS |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2994 | ND | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prairie St Johns | Past | Accepting new patients | |
| PSJ Acquisition LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Psychiatric Hospital
- Fargo, ND
- NPI 1417901000
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043385032",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 111",
"city": "DAVENPORT",
"state": "ND",
"postal_code": "58021",
"telephone_number": "701-371-6550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2925 20TH ST S",
"city": "MOORHEAD",
"state": "MN",
"postal_code": "56560",
"telephone_number": "218-284-0300",
"fax_number": "218-284-5944"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAUL",
"first_name": "JENNIFER",
"middle_name": "JO",
"name_prefix": "Ms.",
"credential": "LCSW IN ND LGSW IN M",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ND",
"license": "2994",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "11233",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10677",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "338K3FA",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Moorhead, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.