1649639873 NPI number — JASMYNE JULIA RAMIREZ-OLSON

Table of content: JASMYNE JULIA RAMIREZ-OLSON (NPI 1649639873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649639873 NPI number — JASMYNE JULIA RAMIREZ-OLSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAMIREZ-OLSON
Provider First Name:
JASMYNE
Provider Middle Name:
JULIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAMIREZ
Provider Other First Name:
JASMYNE
Provider Other Middle Name:
JULIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1649639873
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
241 CROCKER AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THIEF RIVER FALLS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56701-2314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-686-8987
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1165 S COLUMBIA RD STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58201-4007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-686-8987
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/16/2016

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:  22506 , 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)