Active NPI
Jaclyn Rudoni, ATC
- Athletic Trainer
- Thief River Falls, MN
National Provider Identifier
1053702027
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2409
- Practice address
- 101 Knight Ave S
Thief River Falls, MN 56701-2813 - Phone
- (218) 681-7432
- NPI assigned
- Feb 12, 2015
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2409 | MN | Primary |
Addresses
Primary practice location
101 Knight Ave S
Thief River Falls, MN 56701-2813
Mailing address
2301 25TH St S
Fargo, ND 58103-6104
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 |
|---|---|---|---|
| 2409 | MN | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1423699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1423699200000",
"number": "1053702027",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2301 25TH ST S",
"city": "FARGO",
"state": "ND",
"postal_code": "581036104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 KNIGHT AVE S",
"city": "THIEF RIVER FALLS",
"state": "MN",
"postal_code": "567012813",
"telephone_number": "218-681-7432"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDONI",
"first_name": "JACLYN",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-02-12",
"last_updated": "2015-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MN",
"license": "2409",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Thief River Falls, MN
- Riverview Healthcare Association
- Ronco Lifts Inc (Ronco Lifts and Rehab Products)
- Kim J Rosendahl, PT
- Sara L Rosendahl, PAC
- Amanda Rositas Kjos, OTR/L
- Nancy E Rust, PHD
- S&S Rehab Products Plus, Inc.
- Sanford Clinic North (Sanford Pharmacy Thief River Falls 340B)
- Sanford Health Network North (Sanford Thief River Falls Medical Center)
- Sanford Health Network North (Sanford Thief River Falls)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 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.