1588787287 NPI number — MS. JENNIFER NELSON ALBEE LICSW

Table of content: MS. JENNIFER NELSON ALBEE LICSW (NPI 1588787287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588787287 NPI number — MS. JENNIFER NELSON ALBEE LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NELSON ALBEE
Provider First Name:
JENNIFER
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NELSON
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LICSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588787287
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 E 3RD ST
Provider Second Line Business Mailing Address:
ESSENTIA HEALTH DULUTH CLINIC
Provider Business Mailing Address City Name:
DULUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55805-1951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-786-8364
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 E 3RD ST
Provider Second Line Business Practice Location Address:
ESSENTIA HEALTH DULUTH CLINIC
Provider Business Practice Location Address City Name:
DULUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55805-1951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-786-8364
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  15308 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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