Jessica Davis, LCSW
Individual provider Active NPI Social Worker · Rolla, ND
NPI 1679654073 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1679654073
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 3743 (ND)
- Practice address
- 113 Main Ave E
Rolla, ND 58367-7104 - Phone
- (701) 477-3141
- Fax
- (701) 477-8281
- NPI assigned
- Oct 18, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3743 | ND | MD | Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 3743 | ND | Yes |
Addresses
Primary practice location
113 Main Ave E
Rolla, ND 58367-7104
Mailing address
PO Box 650
Devils Lake, ND 58301-0650
Phone (701) 665-2200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 054518 | Medicaid | ND |
Other providers in Rolla, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. 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.