Healthcare Provider Details

I. General information

NPI: 1760507818
Provider Name (Legal Business Name): JASON CARL MERGEN MSW, LGSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 9TH AVE W
ALEXANDRIA MN
56308-2221
US

IV. Provider business mailing address

19241 EBONY RD
OSAKIS MN
56360-4845
US

V. Phone/Fax

Practice location:
  • Phone: 320-763-3912
  • Fax:
Mailing address:
  • Phone: 320-815-1077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number18246
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: