Jennifer Kizima, LICSW

Key facts

NPI

1134549264

Entity type

Individual (NPI type 1)

Primary specialty

Social Worker 104100000X

License

4454 (ND)

Practice address

600 22ND Ave NW Ste B4
Minot, ND 58703-0986

Phone

(701) 720-7733

NPI assigned

Apr 16, 2014

Sex

Female

Sole proprietor

Yes

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Meadowlark Counseling PLLC Mental Health Clinic/Center (Including Community Mental Health Center) · Minot, ND · NPI 1154028645
  NPD Authorized official
• Cass County Social Services Case Management Agency · Fargo, ND · NPI 1487021572
  NPD (past)
• Cass County Social Services Foster Care Agency · Fargo, ND · NPI 1588041685
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 2, 2024.

{
    "created_epoch": "1397606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706832000000",
    "number": "1134549264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3339",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587023339",
            "telephone_number": "701-720-7733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 22ND AVE NW STE B4",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587030986",
            "telephone_number": "701-720-7733"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1010 2nd Ave S",
            "address_purpose": "LOCATION",
            "city": "Fargo",
            "state": "ND",
            "postal_code": "581038226",
            "country_code": "US",
            "telephone_number": "701-239-6822",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIZIMA",
        "first_name": "JENNIFER",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-16",
        "last_updated": "2024-02-02",
        "certification_date": "2024-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ND",
            "license": "4454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Minot, ND · Social Worker in North Dakota