Jillene Marie Bantau
Individual provider Active NPI Specialist · Fergus Falls, MN
NPI 1225528664 · NPPES record last updated Aug 11, 2020
Key facts
- NPI
- 1225528664
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- Practice address
- 1806 E Fir Ave Ste 200
Fergus Falls, MN 56537-3921 - Phone
- (218) 998-2992
- NPI assigned
- May 10, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Behavioral Dimensions, Inc. | Past | Accepting new patients | |
| Solutions Behavioral Healthcare Professionals, PC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | Yes |
Addresses
Primary practice location
1806 E Fir Ave Ste 200
Fergus Falls, MN 56537-3921
Mailing address
891 Belsly Blvd
Moorhead, MN 56560-5055
Other names
- Jillene Marie Braun
Other providers in Fergus Falls, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 11, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.