Healthcare Provider Details

I. General information

NPI: 1578129383
Provider Name (Legal Business Name): JESSICA M LANDIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA M SCHAIBLE

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 1ST ST E STE 3
DICKINSON ND
58601-5267
US

IV. Provider business mailing address

257 1ST ST E STE 3
DICKINSON ND
58601-5267
US

V. Phone/Fax

Practice location:
  • Phone: 701-300-1534
  • Fax: 701-660-1601
Mailing address:
  • Phone: 701-300-1534
  • Fax: 701-660-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5416
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: