1376612606 NPI number — JODI JEAN PINSKE LICSW

Table of content: PRINCESS ANGELICA LOPEZ SAHAGUN PA-C (NPI 1811716590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376612606 NPI number — JODI JEAN PINSKE LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PINSKE
Provider First Name:
JODI
Provider Middle Name:
JEAN
Provider Name Prefix Text:
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:
SWAJA
Provider Other First Name:
JODI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376612606
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 5TH AVENUE EAST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHAKOPEE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-403-9563
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7675 HIGHWAY 13 W
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SAVAGE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55378-1181
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-808-7700
Provider Business Practice Location Address Fax Number:
952-808-7711
Provider Enumeration Date:
11/08/2006

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:  13292 , 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)

  • Identifier: 6293412 . This is a "UBH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 98D69C0 . This is a "BC BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP34907 . This is a "HPARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1023426 . This is a "PREFERREDONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 141873 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".