Individual provider Active NPI

Jennifer Lynn Djonne, MA, LICSW

  • Clinical Social Worker
  • Bemidji, MN
National Provider Identifier
1689820334
Registry record updated Aug 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
13095 Issued in MN
Practice address
722 15TH St NW
Bemidji, MN 56601-2528
Phone
(218) 751-3280
Fax
(218) 751-3298
NPI assigned
Aug 13, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 13095 MN Primary

Addresses

Primary practice location

722 15TH St NW
Bemidji, MN 56601-2528

Mailing address

PO Box 640
Bemidji, MN 56619-0640
Phone (218) 751-3280

Other identifiers 1

IdentifierTypeStateIssuer
644855100MedicaidMN

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)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
13095MNMDPhysician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1218585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1218585600000",
    "number": "1689820334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 640",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566190640",
            "telephone_number": "218-751-3280",
            "fax_number": "218-751-3298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "722 15TH ST NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566012528",
            "telephone_number": "218-751-3280",
            "fax_number": "218-751-3298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DJONNE",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "credential": "MA, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-13",
        "last_updated": "2008-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "13095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "644855100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bemidji, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2008; 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.