MEDICARE: DR. LARRY JEROME WATNEMO LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	ND 392-12-1-97-83	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063568301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY JEROME WATNEMO LPCC

Provider Business Mailing Address
First Line	:	1112 NODAK DR S
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58103-2366
Country	:	US
Telephone Number	:	701-232-6224
Fax Number	:	701-232-4687

Provider Business Practice Location Address
First Line	:	1112 NODAK DR S
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58103-2366
Country	:	US
Telephone Number	:	701-232-6224
Fax Number	:	701-232-4687

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2007
Last Update Date	:	05/20/2020

Similar Medicare Providers

1114018678 — DR. LORI SCHREUR ROTTMAN PH.D.
Practice Location Address:

1112 NODAK DR S
FARGO, ND
58103-2366

Practice Phone: 701-232-6224
Practice Fax: 701-232-4687

1346313616 — MS. ELLEN LOUISE ZAESKE APRN, LICSW
Practice Location Address:

1112 NODAK DR S
FARGO, ND
58103-2366

Practice Phone: 701-232-6224
Practice Fax: 701-232-4687

1396880571 — NAOMI ELIZABETH ERKENBRACK LICSW
Practice Location Address:

1112 NODAK DR S
FARGO, ND
58103-2366

Practice Phone: 701-232-6224
Practice Fax: 701-232-4687

1194946889 — MS. STACEY LYNN WAGNER LSW
Practice Location Address:

1112 NODAK DR S STE 200
FARGO, ND
58103-2366

Practice Phone: 701-280-9545
Practice Fax: 701-280-9520

1710108410 — NANCY LYNN HORTON
Practice Location Address:

1112 NODAK DR S , SUITE 200
FARGO, ND
58103-2366

Practice Phone: 701-280-9545
Practice Fax:

1801017389 — MS. CHRISTINE MARTIN LICSW
Practice Location Address:

1112 NODAK DR S
FARGO, ND
58103-2366

Practice Phone: 701-280-9545
Practice Fax: 701-280-9520

Directions to “ DR. LARRY JEROME WATNEMO LPCC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.