Healthcare Provider Details

I. General information

NPI: 1215178454
Provider Name (Legal Business Name): JAN SCHULTE KUHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 3RD STREET WEST SUITE 301
DICKINSON ND
58601
US

IV. Provider business mailing address

112 3RD STREET WEST SUITE 301
DICKINSON ND
58601
US

V. Phone/Fax

Practice location:
  • Phone: 701-483-9150
  • Fax: 701-483-9154
Mailing address:
  • Phone: 701-483-9150
  • Fax: 701-483-9154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1592
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: