Healthcare Provider Details

I. General information

NPI: 1417746272
Provider Name (Legal Business Name): MARINA FUJIMOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 E SUPERIOR ST STE 415
DULUTH MN
55802-3008
US

IV. Provider business mailing address

1728 E 1ST ST APT 5
DULUTH MN
55812-1720
US

V. Phone/Fax

Practice location:
  • Phone: 218-249-0595
  • Fax:
Mailing address:
  • Phone: 218-491-5289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: