Jodie M Evenson, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

306374 Issued in MN

Practice address

206 Maple Ave E
Mora, MN 55051-1311

Phone

(320) 209-1941

NPI assigned

Nov 28, 2022

Last updated

Nov 28, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jodie M Billstrom Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Serenity Manor

  dba Serenity Haven

  • Substance Abuse Rehabilitation Facility
  • Mora, MN
  • NPI 1689928319
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1669593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669593600000",
    "number": "1275243552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "665 5TH AVE NW",
            "city": "PINE CITY",
            "state": "MN",
            "postal_code": "550631020",
            "telephone_number": "320-209-1941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 MAPLE AVE E",
            "city": "MORA",
            "state": "MN",
            "postal_code": "550511311",
            "telephone_number": "320-209-1941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVENSON",
        "first_name": "JODIE",
        "middle_name": "M",
        "credential": "LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-28",
        "last_updated": "2022-11-28",
        "certification_date": "2022-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "306374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "truedirectionsinc.org",
            "affiliation": "N",
            "address_1": "206 Maple Ave E",
            "city": "Mora",
            "state": "MN",
            "country_code": "US",
            "postal_code": "550511311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JODIE",
            "last_name": "BILLSTROM",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tasha Eggert, LADC
• Jacob Ryan Ellingson, MSPT, SCS, ATC, CSCS
• Barbara Lou Ennis, NP
• Garrett Estenson, PT, DPT, MBA
• Sara Lee Estenson, PT
• Siegfried Feierabend, MD
• Lindsey Deborah Fielder, NP
• Wynonah Filla, PA-C
• Carmichael Finn, MA, LAMFT, LADC
• Janice Lea Fleming, MD

• Addiction (Substance Use Disorder) Counselor in Mora, MN
• Providers in Mora, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.