MEDICARE: JESSICA WALDEMARSEN LICSW

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	1041C0700X	Clinical Social Worker	28179	MN

General Provider Information

NPI Number	:	1679197602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA WALDEMARSEN LICSW

Provider Business Mailing Address
First Line	:	PO BOX 284
Second Line	:
City	:	WILLMAR
State	:	MN
Zip	:	56201-0200
Country	:	US
Telephone Number	:	320-212-8481
Fax Number	:	320-200-7480

Provider Business Practice Location Address
First Line	:	217 INDUSTRIAL DR SW
Second Line	:
City	:	WILLMAR
State	:	MN
Zip	:	56201-2989
Country	:	US
Telephone Number	:	320-212-8481
Fax Number	:	320-200-7480

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

Provider Enumeration Date	:	06/05/2020
Last Update Date	:	06/05/2026

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